MEDICARE: JEANNE HAYNES L.C.S.W.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	R028-214-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MDE395	OTHER	NY	PREFERRED CARE
2	7194349	OTHER	NY	AETNA

General Provider Information

NPI Number	:	1588788491
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEANNE HAYNES L.C.S.W.

Provider Business Mailing Address
First Line	:	920 WINTON RD S
Second Line	:	SUITE A
City	:	ROCHESTER
State	:	NY
Zip	:	14618-1634
Country	:	US
Telephone Number	:	585-271-8361
Fax Number	:	585-271-8361

Provider Business Practice Location Address
First Line	:	920 WINTON RD S
Second Line	:	SUITE A
City	:	ROCHESTER
State	:	NY
Zip	:	14618-1634
Country	:	US
Telephone Number	:	585-271-8361
Fax Number	:	585-271-8361

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/17/2007
Last Update Date	:	07/08/2007

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