Provider Demographics
NPI:1881391738
Name:KEE-HAYNES, DEREK (LCSW)
Entity type:Individual
Prefix:
First Name:DEREK
Middle Name:
Last Name:KEE-HAYNES
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3201 MASTERS DR
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33761-1820
Mailing Address - Country:US
Mailing Address - Phone:813-428-8419
Mailing Address - Fax:
Practice Address - Street 1:6811 N CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33604-5500
Practice Address - Country:US
Practice Address - Phone:727-346-8304
Practice Address - Fax:949-561-4147
Is Sole Proprietor?:No
Enumeration Date:2023-02-10
Last Update Date:2023-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLSW20329OtherPROFESSIONAL LICENSE