Provider Demographics
NPI:1821011842
Name:HAYES, JENNIFER LOUISE (LICSW)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:LOUISE
Last Name:HAYES
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:342 GIFFORD ST UNIT C
Mailing Address - Street 2:
Mailing Address - City:FALMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02540-5107
Mailing Address - Country:US
Mailing Address - Phone:508-495-0554
Mailing Address - Fax:508-495-0559
Practice Address - Street 1:342 GIFFORD ST UNIT C
Practice Address - Street 2:
Practice Address - City:FALMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02540-5107
Practice Address - Country:US
Practice Address - Phone:508-495-0554
Practice Address - Fax:508-495-0559
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA108991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1895907Medicaid
MA32301Medicaid
MA32301Medicaid