Healthcare Provider Details

I. General information

NPI: 1609960327
Provider Name (Legal Business Name): MICHAEL HAYMES PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 02/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

494 MAIN ST
CROMWELL CT
06416-2040
US

IV. Provider business mailing address

494 MAIN ST SUITE 200
CROMWELL CT
06416-2040
US

V. Phone/Fax

Practice location:
  • Phone: 860-632-1296
  • Fax:
Mailing address:
  • Phone: 860-632-1296
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number749
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number749
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number749
License Number StateCT
# 4
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number749
License Number StateCT
# 5
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number749
License Number StateCT
# 6
Primary TaxonomyN
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License Number749
License Number StateCT
# 7
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number749
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: