Provider Demographics
NPI:1386019917
Name:HYNES, ANTHONY MARTIN
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:MARTIN
Last Name:HYNES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7602 16TH AVE
Mailing Address - Street 2:7602 16TH AVENUE
Mailing Address - City:TAKOMA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20912-7038
Mailing Address - Country:US
Mailing Address - Phone:240-751-3627
Mailing Address - Fax:
Practice Address - Street 1:7602 16TH AVENUE
Practice Address - Street 2:
Practice Address - City:TAKOMA PARK
Practice Address - State:MD
Practice Address - Zip Code:20912
Practice Address - Country:US
Practice Address - Phone:240-751-3627
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-08
Last Update Date:2015-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD0589THOtherSPECIALIST