Provider Demographics
NPI:1780643205
Name:HAYES, STEPHEN MICHAEL (LCSW)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:MICHAEL
Last Name:HAYES
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1008 LISBON ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04240-5721
Mailing Address - Country:US
Mailing Address - Phone:207-753-0323
Mailing Address - Fax:207-753-0323
Practice Address - Street 1:1008 LISBON ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-5721
Practice Address - Country:US
Practice Address - Phone:207-753-0323
Practice Address - Fax:207-753-0323
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-22
Last Update Date:2013-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC3649101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME213920000Medicaid
ME213920000Medicaid