Healthcare Provider Details

I. General information

NPI: 1659841757
Provider Name (Legal Business Name): JOHN LENOX HAINES
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/30/2018
Last Update Date: 11/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 W 31ST ST FL 3
NEW YORK NY
10001-3407
US

IV. Provider business mailing address

135 W 16TH ST APT 56
NEW YORK NY
10011-6292
US

V. Phone/Fax

Practice location:
  • Phone: 917-991-8417
  • Fax:
Mailing address:
  • Phone: 317-418-3953
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: