MEDICARE: HAYWARD JOSEPH MOUTON LCSW

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	0904013560	VA
2	1041C0700X	Clinical Social Worker	23304	MD
3	1041C0700X	Clinical Social Worker	LC50082268	DC
4	1041C0700X	Clinical Social Worker	098839	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1992300206
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HAYWARD JOSEPH MOUTON LCSW

Provider Business Mailing Address
First Line	:	1672 PARK AVE APT 3D
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10035-4653
Country	:	US
Telephone Number	:	332-223-9613
Fax Number	:

Provider Business Practice Location Address
First Line	:	1672 PARK AVE APT 3D
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10035-4653
Country	:	US
Telephone Number	:	332-223-9613
Fax Number	:

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

Provider Enumeration Date	:	12/03/2020
Last Update Date	:	01/06/2025

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