Provider Demographics
NPI:1114127958
Name:TIMOTHY P. HAYES, PH.D., CLINICAL PSYCHOLOGIST, P.C.
Entity Type:Organization
Organization Name:TIMOTHY P. HAYES, PH.D., CLINICAL PSYCHOLOGIST, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:P
Authorized Official - Last Name:HAYES
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:315-422-1722
Mailing Address - Street 1:315 S CROUSE AVE
Mailing Address - Street 2:SUITE 301
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13210-1845
Mailing Address - Country:US
Mailing Address - Phone:315-422-1722
Mailing Address - Fax:315-422-1741
Practice Address - Street 1:315 S CROUSE AVE
Practice Address - Street 2:SUITE 301
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-1845
Practice Address - Country:US
Practice Address - Phone:315-422-1722
Practice Address - Fax:315-422-1741
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-19
Last Update Date:2008-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012381103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYBA1186Medicare UPIN