Provider Demographics
NPI:1417936667
Name:HAYNES, KAMLYN (MD)
Entity Type:Individual
Prefix:DR
First Name:KAMLYN
Middle Name:
Last Name:HAYNES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47 PROSPECT ST
Mailing Address - Street 2:
Mailing Address - City:WEST BOYLSTON
Mailing Address - State:MA
Mailing Address - Zip Code:01583-1301
Mailing Address - Country:US
Mailing Address - Phone:781-608-2241
Mailing Address - Fax:508-835-4418
Practice Address - Street 1:47 PROSPECT ST
Practice Address - Street 2:
Practice Address - City:WEST BOYLSTON
Practice Address - State:MA
Practice Address - Zip Code:01583-1301
Practice Address - Country:US
Practice Address - Phone:781-608-2241
Practice Address - Fax:508-835-4418
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-15
Last Update Date:2021-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1585252084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry