MEDICARE: IRENE HAYDEN LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	0904002062	VA
2	1041C0700X	Clinical Social Worker	C006956	NC

General Provider Information

NPI Number	:	1215046891
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IRENE HAYDEN LCSW

Provider Business Mailing Address
First Line	:	51 OLD GROVE LN
Second Line	:
City	:	APEX
State	:	NC
Zip	:	27502-1893
Country	:	US
Telephone Number	:	703-505-3047
Fax Number	:

Provider Business Practice Location Address
First Line	:	51 OLD GROVE LN
Second Line	:
City	:	APEX
State	:	NC
Zip	:	27502-1893
Country	:	US
Telephone Number	:	703-505-3047
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/29/2006
Last Update Date	:	05/21/2015

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