Provider Information for 1588202915
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MARY HAYNES LCSW
Sex: Female
NPI: 1588202915
Last Updated: 2019-12-17
Certification Date: 2019-12-17
Certification Date: 2019-12-17
Details
| Name | Value | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| NPI | 1588202915 | ||||||||
| Enumeration Date | 2019-12-17 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | YES | ||||||||
| Status | Active | ||||||||
| Mailing Address | PO BOX 1018 PETALUMA, CA 94953-1018 United States Phone: 707-815-4604 | Fax: | ||||||||
| Primary Practice Address | 6510 PETERSEN RD PETALUMA, CA 94952-9223 United States Phone: 707-815-4604 | Fax: | ||||||||
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