Provider Demographics
NPI:1841639705
Name:HAY, HEATHER LYNN (PHD, LMFT)
Entity type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:LYNN
Last Name:HAY
Suffix:
Gender:F
Credentials:PHD, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6361 KILLOE RD
Mailing Address - Street 2:
Mailing Address - City:BALDWINSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13027-9073
Mailing Address - Country:US
Mailing Address - Phone:315-409-9790
Mailing Address - Fax:
Practice Address - Street 1:2100 E GENESEE ST
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-2249
Practice Address - Country:US
Practice Address - Phone:315-409-9790
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-24
Last Update Date:2016-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000143-1106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist