Provider Demographics
NPI:1013118827
Name:HAYNES, ROBERT BRUCE (MA)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:BRUCE
Last Name:HAYNES
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2255 OLD MARLTON PIKE E
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-2666
Mailing Address - Country:US
Mailing Address - Phone:609-417-7300
Mailing Address - Fax:856-988-2998
Practice Address - Street 1:440 BENIGNO BLVD
Practice Address - Street 2:
Practice Address - City:BELLMAWR
Practice Address - State:NJ
Practice Address - Zip Code:08031-2517
Practice Address - Country:US
Practice Address - Phone:609-670-1937
Practice Address - Fax:856-988-2998
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC000421101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional