Provider Demographics
NPI:1417473562
Name:HAYES, ELLA LYNK (MSW)
Entity Type:Individual
Prefix:MS
First Name:ELLA
Middle Name:LYNK
Last Name:HAYES
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:98 CHERRY LN
Mailing Address - Street 2:
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666
Mailing Address - Country:US
Mailing Address - Phone:1201-294-6528
Mailing Address - Fax:
Practice Address - Street 1:98 CHERRY LN
Practice Address - Street 2:
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-0766
Practice Address - Country:US
Practice Address - Phone:120-129-4652
Practice Address - Fax:201-294-6528
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-21
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL06250100104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
XXXXXXXXXXXXXOtherXXXXXXXXXXXXXX
XXXXXXXXXXXXXXXXXXXXOtherPRIVATE INSURANCE