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General NPI Number Information
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NPI Number | 1093597023
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Entity Type | Individual
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Provider Name | CARA J. HAYNES PSYD
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Gender | Female
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Dates
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Enumeration Date | 10/16/2023
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Last Update Date | 06/19/2024
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Provider Practice Location Address
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Address Line | 2675 N MAYFAIR RD STE 400
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City | MILWAUKEE
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State | WI
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Zip | 53226-1305
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Country | US
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Telephone | 414-763-6910
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Fax | 414-763-6911
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Provider Business Mailing Address
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Address Line | 7984 NEW LA GRANGE RD
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City | LOUISVILLE
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State | KY
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Zip | 40222-4718
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Country | US
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Telephone | 502-426-2777
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Fax | 502-426-2776
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 167176
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License Number State | KY
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