MEDICARE: DR. LAURA COOK HAYWARD PH.D.

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	019803	NY

General Provider Information

NPI Number	:	1689927311
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LAURA COOK HAYWARD PH.D.

Provider Business Mailing Address
First Line	:	800 IRVING AVE
Second Line	:
City	:	SYRACUSE
State	:	NY
Zip	:	13210-2716
Country	:	US
Telephone Number	:	315-425-4400
Fax Number	:

Provider Business Practice Location Address
First Line	:	620 ERIE BLVD W
Second Line	:
City	:	SYRACUSE
State	:	NY
Zip	:	13204-2445
Country	:	US
Telephone Number	:	315-425-4400
Fax Number	:

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

Provider Enumeration Date	:	10/18/2012
Last Update Date	:	10/18/2012

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