Healthcare Provider Details

I. General information

NPI: 1356437131
Provider Name (Legal Business Name): JUDY HAYMAN PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 IRVING AVENUE SYRACUSE VA MEDICAL CENTER BVAC (116)
SYRACUSE NY
13210-2716
US

IV. Provider business mailing address

800 IRVING AVENUE SYRACUSE VA MEDICAL CENTER BVAC (116)
SYRACUSE NY
13210-2716
US

V. Phone/Fax

Practice location:
  • Phone: 315-425-3443
  • Fax: 315-425-3447
Mailing address:
  • Phone: 315-425-3443
  • Fax: 315-425-3447

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number014760-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: