Provider Demographics
NPI:1174851091
Name:HAYES, JACQUELINE
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:HAYES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:678 MASSACHUSETTS AVE
Mailing Address - Street 2:502
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02139-3355
Mailing Address - Country:US
Mailing Address - Phone:617-234-5340
Mailing Address - Fax:617-234-5344
Practice Address - Street 1:678 MASSACHUSETTS AVE
Practice Address - Street 2:502
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02139-3355
Practice Address - Country:US
Practice Address - Phone:617-234-5340
Practice Address - Fax:617-234-5344
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-04
Last Update Date:2009-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator