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General NPI Number Information
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NPI Number | 1073940680
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Entity Type | Individual
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Provider Name | ADAM L HAYNES L.C.S.W.
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Gender | Male
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Dates
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Enumeration Date | 09/27/2013
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Last Update Date | 11/20/2020
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Provider Practice Location Address
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Address Line | 5117 MOUNT ROYAL DR
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City | LOS ANGELES
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State | CA
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Zip | 90041-1331
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Country | US
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Telephone | 818-317-2661
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 412214
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City | LOS ANGELES
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State | CA
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Zip | 90041-9214
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Country | US
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Telephone | 818-317-2661
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 74673
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License Number State | CA
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