Provider Demographics
NPI:1194035998
Name:HAYNES, KERRY A
Entity Type:Individual
Prefix:
First Name:KERRY
Middle Name:A
Last Name:HAYNES
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 1:14 SYCAMORE WAY
Mailing Address - Street 2:
Mailing Address - City:BRANFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06405-6551
Mailing Address - Country:US
Mailing Address - Phone:203-483-2645
Mailing Address - Fax:203-483-2648
Practice Address - Street 1:14 SYCAMORE WAY
Practice Address - Street 2:
Practice Address - City:BRANFORD
Practice Address - State:CT
Practice Address - Zip Code:06405-6551
Practice Address - Country:US
Practice Address - Phone:203-483-2630
Practice Address - Fax:203-483-2644
Is Sole Proprietor?:No
Enumeration Date:2010-10-14
Last Update Date:2010-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health