Provider Demographics
NPI:1952118531
Name:HAYES, JANE (LICAC)
Entity type:Individual
Prefix:
First Name:JANE
Middle Name:
Last Name:HAYES
Suffix:
Gender:F
Credentials:LICAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49 ALBION ST
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02155-6440
Mailing Address - Country:US
Mailing Address - Phone:617-586-3463
Mailing Address - Fax:
Practice Address - Street 1:49 ALBION ST
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02155-6440
Practice Address - Country:US
Practice Address - Phone:617-586-3463
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-16
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6014186171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist