Individual provider Active NPI

Darlene Marie Haviland, PAC

  • Physician Assistant
  • Enfield, CT
National Provider Identifier
1720067879
Registry record updated Jul 13, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
001494 Issued in CT
Practice address
113 Elm St
Enfield, CT 06082-3700
Phone
(860) 741-2225
Fax
(860) 741-2229
NPI assigned
Jan 16, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 001494 CT Primary

Addresses

Primary practice location

113 Elm St
Enfield, CT 06082-3700

Mailing address

25 Pine Grove Dr
South Hadley, MA 01075-2196
Phone (508) 832-9572

Other identifiers 1

IdentifierTypeStateIssuer
290001494CT01OtherCTANTHEM BLUE CROSS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
001494CTMDCounselor

Practice roles

OrganizationSpecialtyStatusNew patients
New England Dermatology, P.C. Past Accepting new patients
CRV Dermatology LLC Physician Assistant PastSince May 1, 2006 Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1137369600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1720067879",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25 PINE GROVE DR",
            "city": "SOUTH HADLEY",
            "state": "MA",
            "postal_code": "010752196",
            "telephone_number": "508-832-9572",
            "fax_number": "508-832-4758"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "113 ELM ST",
            "city": "ENFIELD",
            "state": "CT",
            "postal_code": "060823700",
            "telephone_number": "860-741-2225",
            "fax_number": "860-741-2229"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HAVILAND",
        "first_name": "DARLENE",
        "middle_name": "MARIE",
        "name_prefix": "Ms.",
        "credential": "PAC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-01-16",
        "last_updated": "2026-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CT",
            "license": "001494",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BLUE CROSS",
            "identifier": "290001494CT01",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Enfield, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.