Provider Demographics
NPI:1528230794
Name:HAYWARD, KATIE M (LCSW)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:M
Last Name:HAYWARD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:
Other - Last Name:BRYANT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:62 PEGASUS ST STE 200
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:ME
Mailing Address - Zip Code:04011-5028
Mailing Address - Country:US
Mailing Address - Phone:207-373-0620
Mailing Address - Fax:
Practice Address - Street 1:62 PEGASUS ST STE 200
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:ME
Practice Address - Zip Code:04011-5028
Practice Address - Country:US
Practice Address - Phone:207-373-0620
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-28
Last Update Date:2015-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC117751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical