Provider Demographics
NPI:1881816528
Name:HAYNES, LYNN MARIE (LISW)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:MARIE
Last Name:HAYNES
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:323 DARTMOUTH DR SE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-2221
Mailing Address - Country:US
Mailing Address - Phone:505-238-9551
Mailing Address - Fax:505-843-9599
Practice Address - Street 1:1415 UNIVERSITY BLVD NE
Practice Address - Street 2:SUITE D
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-1716
Practice Address - Country:US
Practice Address - Phone:505-238-9551
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMI-058331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical