Healthcare Provider Details

I. General information

NPI: 1760544720
Provider Name (Legal Business Name): MICHAEL HAYMES, PH.D.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2006
Last Update Date: 02/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

494 MAIN ST SUITE 100
CROMWELL CT
06416-2040
US

IV. Provider business mailing address

494 MAIN ST SUITE 100
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 Code103TC0700X
TaxonomyClinical Psychologist
License Number749
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHAEL HAYMES
Title or Position: PSYCHOLOGIST
Credential: PH.D.
Phone: 860-632-1296