Provider Demographics
NPI:1033223342
Name:HAYES, BRENDA T (LCSW)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:T
Last Name:HAYES
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:BRENDA
Other - Middle Name:L
Other - Last Name:HAYES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:217 WAKELAND DR
Mailing Address - Street 2:
Mailing Address - City:STEPHENS CITY
Mailing Address - State:VA
Mailing Address - Zip Code:22655-2332
Mailing Address - Country:US
Mailing Address - Phone:914-584-7915
Mailing Address - Fax:845-350-4036
Practice Address - Street 1:217 WAKELAND DR
Practice Address - Street 2:
Practice Address - City:STEPHENS CITY
Practice Address - State:VA
Practice Address - Zip Code:22655-2332
Practice Address - Country:US
Practice Address - Phone:914-584-7915
Practice Address - Fax:845-350-4036
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2014-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR024612-11041C0700X, 1041C0700X
VA09040080741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY7389OtherBCD
NYR024612-1OtherLCSW LICENSE
NY027052OtherVALUE OPTIONS
VA0904008074OtherVIRGINIA LICENSE
VA1033223342Medicare PIN
NY7389OtherBCD