Healthcare Provider Details

I. General information

NPI: 1619219839
Provider Name (Legal Business Name): ROBERT HAYES PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2013
Last Update Date: 03/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28 MALLARD CT
BECKLEY WV
25801-3664
US

IV. Provider business mailing address

28 MALLARD CT
BECKLEY WV
25801-3664
US

V. Phone/Fax

Practice location:
  • Phone: 304-252-8409
  • Fax:
Mailing address:
  • Phone: 304-252-8409
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: