Provider Demographics
NPI:1073078416
Name:HAYWOOD, DANIEL (MA, RDT, LCAT)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:
Last Name:HAYWOOD
Suffix:
Gender:M
Credentials:MA, RDT, LCAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1143 30TH RD FL 2
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11102-4032
Mailing Address - Country:US
Mailing Address - Phone:347-776-0391
Mailing Address - Fax:
Practice Address - Street 1:112 W 27TH ST STE 402
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-6241
Practice Address - Country:US
Practice Address - Phone:347-776-0391
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-08
Last Update Date:2019-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001688-1221700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist