Provider Demographics
NPI:1184967556
Name:HAYWOOD, DANA MARIE (PHD)
Entity type:Individual
Prefix:DR
First Name:DANA
Middle Name:MARIE
Last Name:HAYWOOD
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:549 E 12TH ST APT 4C
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10009-3848
Mailing Address - Country:US
Mailing Address - Phone:646-317-1151
Mailing Address - Fax:646-317-1152
Practice Address - Street 1:635 W 165TH ST FL 6
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-3724
Practice Address - Country:US
Practice Address - Phone:646-317-1151
Practice Address - Fax:646-317-1152
Is Sole Proprietor?:No
Enumeration Date:2013-04-03
Last Update Date:2014-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020627103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist