Provider Demographics
NPI:1093891160
Name:HAYES, ELAINE E (LICSW)
Entity Type:Individual
Prefix:MS
First Name:ELAINE
Middle Name:E
Last Name:HAYES
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:72 GORHAM RD
Mailing Address - Street 2:
Mailing Address - City:HARWICH PORT
Mailing Address - State:MA
Mailing Address - Zip Code:02646-1324
Mailing Address - Country:US
Mailing Address - Phone:508-237-2337
Mailing Address - Fax:
Practice Address - Street 1:23 BAY STATE CT
Practice Address - Street 2:
Practice Address - City:BREWSTER
Practice Address - State:MA
Practice Address - Zip Code:02631-2120
Practice Address - Country:US
Practice Address - Phone:508-237-2337
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2009-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10294331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAPO7846OtherBC/BS
MAPO7846OtherBC/BS