Provider Demographics
NPI:1033187836
Name:HAYNES, BARBARA ANNETTE (PHD)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:ANNETTE
Last Name:HAYNES
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3594 E TREMONT AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10465-2032
Mailing Address - Country:US
Mailing Address - Phone:718-792-4178
Mailing Address - Fax:718-792-2496
Practice Address - Street 1:3594 E TREMONT AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10465-2032
Practice Address - Country:US
Practice Address - Phone:718-792-4178
Practice Address - Fax:718-792-2496
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011676103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY14020022OtherANTHEM
NYP821456OtherOXFORD
NY6899955OtherGHI
NY146600OtherVALUE OPTIONS
NYVO5011Medicare ID - Type Unspecified