Provider Demographics
NPI:1790447191
Name:HAYMES-ELLIOTT, LINDA (PHD, BCBA-D)
Entity Type:Individual
Prefix:DR
First Name:LINDA
Middle Name:
Last Name:HAYMES-ELLIOTT
Suffix:
Gender:F
Credentials:PHD, BCBA-D
Other - Prefix:DR
Other - First Name:LINDA
Other - Middle Name:
Other - Last Name:HAYMES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD, BCBA-D
Mailing Address - Street 1:6827 RIDGEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94611-1309
Mailing Address - Country:US
Mailing Address - Phone:510-427-2345
Mailing Address - Fax:
Practice Address - Street 1:6827 RIDGEWOOD DR
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94611-1309
Practice Address - Country:US
Practice Address - Phone:510-427-2345
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-12
Last Update Date:2021-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY15970103TC0700X
1-12-12131103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
11212131OtherBEHAVIOR ANALYST CERTIFICATION BOARD
CAPSY15970OtherBOARD OF PSYCHOLOGY