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General NPI Number Information
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NPI Number | 1184967556
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Entity Type | Individual
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Provider Name | DANA MARIE HAYWOOD PH.D.
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Gender | Female
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Dates
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Enumeration Date | 04/03/2013
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Last Update Date | 09/25/2014
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Provider Practice Location Address
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Address Line | 635 W 165TH ST FL 6
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City | NEW YORK
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State | NY
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Zip | 10032-3724
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Country | US
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Telephone | 646-317-1151
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Fax | 646-317-1152
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Provider Business Mailing Address
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Address Line | 549 E 12TH ST APT 4C
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City | NEW YORK
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State | NY
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Zip | 10009-3848
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Country | US
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Telephone | 646-317-1151
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Fax | 646-317-1152
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 020627
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License Number State | NY
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