Provider Demographics
NPI:1356437131
Name:HAYMAN, JUDY (PHD)
Entity type:Individual
Prefix:
First Name:JUDY
Middle Name:
Last Name:HAYMAN
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 1:800 IRVING AVENUE
Mailing Address - Street 2:SYRACUSE VA MEDICAL CENTER BVAC (116)
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13210-2716
Mailing Address - Country:US
Mailing Address - Phone:315-425-3443
Mailing Address - Fax:315-425-3447
Practice Address - Street 1:800 IRVING AVENUE
Practice Address - Street 2:SYRACUSE VA MEDICAL CENTER BVAC (116)
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-2716
Practice Address - Country:US
Practice Address - Phone:315-425-3443
Practice Address - Fax:315-425-3447
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014760-1103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02311255Medicaid
NYDD3061Medicare ID - Type Unspecified