Provider Demographics
NPI:1386847002
Name:HAYNE, SUZANNE (LMFT)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:
Last Name:HAYNE
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2325 CLEMENT AVE
Mailing Address - Street 2:
Mailing Address - City:ALAMEDA
Mailing Address - State:CA
Mailing Address - Zip Code:94501-1421
Mailing Address - Country:US
Mailing Address - Phone:510-522-8363
Mailing Address - Fax:510-865-1930
Practice Address - Street 1:1516 OAK ST STE 314
Practice Address - Street 2:
Practice Address - City:ALAMEDA
Practice Address - State:CA
Practice Address - Zip Code:94501-2958
Practice Address - Country:US
Practice Address - Phone:510-594-4310
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-08
Last Update Date:2017-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106H00000X
CA79590106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist