Provider Demographics
NPI:1720298730
Name:HAYES, STEPHANIE CAROLINE (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:CAROLINE
Last Name:HAYES
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54 VILLAGE HILL DR
Mailing Address - Street 2:
Mailing Address - City:DIX HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11746-5523
Mailing Address - Country:US
Mailing Address - Phone:631-858-1879
Mailing Address - Fax:
Practice Address - Street 1:54 VILLAGE HILL DR
Practice Address - Street 2:
Practice Address - City:DIX HILLS
Practice Address - State:NY
Practice Address - Zip Code:11746-5523
Practice Address - Country:US
Practice Address - Phone:631-858-1879
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY067900-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker