Healthcare Provider Details

I. General information

NPI: 1073927166
Provider Name (Legal Business Name): SONIA HAYNES LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2014
Last Update Date: 01/06/2021
Certification Date: 01/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 E 172ND ST FL 3
BRONX NY
10460-5802
US

IV. Provider business mailing address

150 E 45TH ST
NEW YORK NY
10017-3115
US

V. Phone/Fax

Practice location:
  • Phone: 347-767-2200
  • Fax:
Mailing address:
  • Phone: 212-949-4800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number1909277
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number099966
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC05873300
License Number StateNJ
# 4
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number090692
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: