Healthcare Provider Details

I. General information

NPI: 1407611825
Provider Name (Legal Business Name): CHYNA C HAYWOOD LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/15/2024
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

418 BROADWAY STE R
ALBANY NY
12207-2922
US

IV. Provider business mailing address

418 BROADWAY #STE R
ALBANY NY
12207
US

V. Phone/Fax

Practice location:
  • Phone: 929-400-3294
  • Fax:
Mailing address:
  • Phone: 929-400-3294
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number099618-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: