Provider Demographics
NPI:1053486209
Name:HAYNES, LATHROP T (PHD)
Entity Type:Individual
Prefix:DR
First Name:LATHROP
Middle Name:T
Last Name:HAYNES
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:LATHE
Other - Middle Name:
Other - Last Name:HAYNES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:401 SHADY AVE
Mailing Address - Street 2:SUITE C107
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15206-4459
Mailing Address - Country:US
Mailing Address - Phone:412-361-6336
Mailing Address - Fax:412-361-5456
Practice Address - Street 1:401 SHADY AVE
Practice Address - Street 2:SUITE C107
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15206-4459
Practice Address - Country:US
Practice Address - Phone:412-361-6336
Practice Address - Fax:412-361-5456
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS-005377-L103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA569856Medicare UPIN
PA569856Medicare ID - Type Unspecified