Provider Demographics
NPI:1891123055
Name:HAYES, GWENDOLYN (LCSW)
Entity Type:Individual
Prefix:
First Name:GWENDOLYN
Middle Name:
Last Name:HAYES
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1577 CONGRESS ST 2ND FLOOR
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04102-2169
Mailing Address - Country:US
Mailing Address - Phone:207-662-5522
Mailing Address - Fax:207-662-5526
Practice Address - Street 1:1577 CONGRESS ST 2ND FLOOR
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102-2169
Practice Address - Country:US
Practice Address - Phone:207-662-5522
Practice Address - Fax:207-662-5526
Is Sole Proprietor?:No
Enumeration Date:2013-10-28
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC205741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical