MEDICARE: DR. LISA JEANETTE HAYDEN PSYD

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	103TC0700X	Clinical Psychologist	PSY17034	CA

General Provider Information

NPI Number	:	1639238660
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LISA JEANETTE HAYDEN PSYD

Provider Business Mailing Address
First Line	:	816 CAMARILLO SPRINGS RD
Second Line	:	STE A
City	:	CAMARILLO
State	:	CA
Zip	:	93012-9441
Country	:	US
Telephone Number	:	805-384-1100
Fax Number	:	805-384-1105

Provider Business Practice Location Address
First Line	:	816 CAMARILLO SPRINGS RD
Second Line	:	STE A
City	:	CAMARILLO
State	:	CA
Zip	:	93012-9441
Country	:	US
Telephone Number	:	805-384-1100
Fax Number	:	805-384-1105

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

Provider Enumeration Date	:	12/06/2006
Last Update Date	:	12/28/2018

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