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General NPI Number Information
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NPI Number | 1578788105
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Entity Type | Individual
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Provider Name | AMY DENEALE HAYNES PSY.D.
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Gender | Female
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Dates
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Enumeration Date | 04/17/2007
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Last Update Date | 04/20/2021
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Provider Practice Location Address
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Address Line | 768 PLEASANT VALLEY RD STE 201
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City | DIAMOND SPRINGS
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State | CA
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Zip | 95619-9260
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Country | US
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Telephone | 530-621-6339
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Fax |
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Provider Business Mailing Address
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Address Line | 5716 FOLSOM BLVD # 336
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City | SACRAMENTO
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State | CA
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Zip | 95819-4608
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Country | US
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Telephone | 831-206-1392
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 21297
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License Number State | CA
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