Provider Demographics
NPI:1689939829
Name:MYERS, HAYWARD RG
Entity Type:Individual
Prefix:
First Name:HAYWARD
Middle Name:RG
Last Name:MYERS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 ALPHA RD
Mailing Address - Street 2:
Mailing Address - City:DORCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:02124-2112
Mailing Address - Country:US
Mailing Address - Phone:617-291-4818
Mailing Address - Fax:
Practice Address - Street 1:18 ALPHA RD
Practice Address - Street 2:
Practice Address - City:DORCHESTER
Practice Address - State:MA
Practice Address - Zip Code:02124-2112
Practice Address - Country:US
Practice Address - Phone:617-291-4818
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-12
Last Update Date:2012-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor