Healthcare Provider Details

I. General information

NPI: 1083218804
Provider Name (Legal Business Name): JUDITH ANN BENSINGER HAYNES MED, MA, LMFT 114669
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/23/2020
Last Update Date: 11/23/2020
Certification Date: 11/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

954 RISA RD STE A
LAFAYETTE CA
94549-3418
US

IV. Provider business mailing address

954 RISA RD STE A
LAFAYETTE CA
94549-3418
US

V. Phone/Fax

Practice location:
  • Phone: 925-683-3274
  • Fax:
Mailing address:
  • Phone: 925-683-3274
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number114669
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: