Provider Demographics
NPI:1619087087
Name:HAYES, TIMOTHY P (PHD)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:P
Last Name:HAYES
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 S CROUSE AVE
Mailing Address - Street 2:SUITE 301
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13210-1845
Mailing Address - Country:US
Mailing Address - Phone:315-422-1722
Mailing Address - Fax:315-422-1741
Practice Address - Street 1:315 S CROUSE AVE
Practice Address - Street 2:SUITE 301
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-1845
Practice Address - Country:US
Practice Address - Phone:315-422-1722
Practice Address - Fax:315-422-1741
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2008-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012381103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYRB4558Medicare UPIN