Provider Demographics
NPI:1578120432
Name:HASKINS, DAYNA B
Entity Type:Individual
Prefix:
First Name:DAYNA
Middle Name:B
Last Name:HASKINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:631 TALCOTTVILLE RD APT M22
Mailing Address - Street 2:
Mailing Address - City:VERNON
Mailing Address - State:CT
Mailing Address - Zip Code:06066-2382
Mailing Address - Country:US
Mailing Address - Phone:860-986-8473
Mailing Address - Fax:
Practice Address - Street 1:631 TALCOTTVILLE RD APT M22
Practice Address - Street 2:
Practice Address - City:VERNON
Practice Address - State:CT
Practice Address - Zip Code:06066-2382
Practice Address - Country:US
Practice Address - Phone:860-986-8473
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-24
Last Update Date:2019-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT600890003627963Medicaid