Provider Demographics
NPI:1871071696
Name:HAVERKAMP, CAROLINE MARIE (BCBA)
Entity type:Individual
Prefix:MRS
First Name:CAROLINE
Middle Name:MARIE
Last Name:HAVERKAMP
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 MAIN ST S
Mailing Address - Street 2:
Mailing Address - City:MINOT
Mailing Address - State:ND
Mailing Address - Zip Code:58701-3914
Mailing Address - Country:US
Mailing Address - Phone:702-370-8030
Mailing Address - Fax:
Practice Address - Street 1:100 MAIN ST S
Practice Address - Street 2:
Practice Address - City:MINOT
Practice Address - State:ND
Practice Address - Zip Code:58701-3914
Practice Address - Country:US
Practice Address - Phone:702-370-8030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-02
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-20-42989103K00000X
NVRBT-18-61741106S00000X
NDL89103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician