Provider Demographics
NPI:1730283458
Name:HAIMES, JANE T (PMHNP, LCSW, FNP)
Entity Type:Individual
Prefix:MS
First Name:JANE
Middle Name:T
Last Name:HAIMES
Suffix:
Gender:F
Credentials:PMHNP, LCSW, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 SHORE RD
Mailing Address - Street 2:
Mailing Address - City:OLD GREENWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06870-2421
Mailing Address - Country:US
Mailing Address - Phone:203-249-9494
Mailing Address - Fax:
Practice Address - Street 1:1200 HIGH RIDGE RD
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06905-1223
Practice Address - Country:US
Practice Address - Phone:203-548-7703
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-12
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0030611041C0700X
NY0967081041C0700X
NY338925363LF0000X
NYF404052-01363LP0808X
CT10876363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily