Healthcare Provider Details

I. General information

NPI: 1366583668
Provider Name (Legal Business Name): BRENDAN TIMOTHY HAYES LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2007
Last Update Date: 10/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 N 2ND ST
RICHMOND VA
23219-1359
US

IV. Provider business mailing address

PO BOX 91734
RICHMOND VA
23291-1734
US

V. Phone/Fax

Practice location:
  • Phone: 804-828-2000
  • Fax: 804-828-7814
Mailing address:
  • Phone: 804-358-6100
  • Fax: 804-342-7619

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904002486
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: