Healthcare Provider Details

I. General information

NPI: 1881816528
Provider Name (Legal Business Name): LYNN MARIE HAYNES LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 02/20/2025
Certification Date: 02/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4010 CARLISLE BLVD NE STE G
ALBUQUERQUE NM
87107-4532
US

IV. Provider business mailing address

221 TORNASOL LN NE
ALBUQUERQUE NM
87113-1214
US

V. Phone/Fax

Practice location:
  • Phone: 505-238-9551
  • Fax:
Mailing address:
  • Phone: 505-238-9551
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI-05833
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC-05833
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: