Provider Demographics
NPI:1639238660
Name:HAYDEN, LISA JEANETTE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:JEANETTE
Last Name:HAYDEN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:816 CAMARILLO SPRINGS RD
Mailing Address - Street 2:STE A
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93012-9441
Mailing Address - Country:US
Mailing Address - Phone:805-384-1100
Mailing Address - Fax:805-384-1105
Practice Address - Street 1:816 CAMARILLO SPRINGS RD
Practice Address - Street 2:STE A
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93012-9441
Practice Address - Country:US
Practice Address - Phone:805-384-1100
Practice Address - Fax:805-384-1105
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2018-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY17034103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACP17034Medicare UPIN