Healthcare Provider Details

I. General information

NPI: 1033223342
Provider Name (Legal Business Name): BRENDA T. HAYES LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: BRENDA L. HAYES LCSW

II. Dates (important events)

Enumeration Date: 08/17/2006
Last Update Date: 02/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

217 WAKELAND DR
STEPHENS CITY VA
22655-2332
US

IV. Provider business mailing address

217 WAKELAND DR
STEPHENS CITY VA
22655-2332
US

V. Phone/Fax

Practice location:
  • Phone: 914-584-7915
  • Fax: 845-350-4036
Mailing address:
  • Phone: 914-584-7915
  • Fax: 845-350-4036

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberR024612-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904008074
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: