Provider Demographics
NPI:1356494538
Name:HAINES, AMBER LYNN (LICSW)
Entity Type:Individual
Prefix:MS
First Name:AMBER
Middle Name:LYNN
Last Name:HAINES
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 1:55 NORTH RD STE 220
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01730-1078
Mailing Address - Country:US
Mailing Address - Phone:781-825-5714
Mailing Address - Fax:781-275-1770
Practice Address - Street 1:55 NORTH RD STE 220
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:01730
Practice Address - Country:US
Practice Address - Phone:781-825-5714
Practice Address - Fax:781-275-1770
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2019-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1148801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical