Provider Demographics
NPI:1194210740
Name:HAYDEN, EMMET O'SHEA (RBT)
Entity type:Individual
Prefix:
First Name:EMMET
Middle Name:O'SHEA
Last Name:HAYDEN
Suffix:
Gender:M
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:72 DARTMOUTH DR
Mailing Address - Street 2:
Mailing Address - City:LARKSPUR
Mailing Address - State:CA
Mailing Address - Zip Code:94939-1105
Mailing Address - Country:US
Mailing Address - Phone:415-606-6111
Mailing Address - Fax:
Practice Address - Street 1:72 DARTMOUTH DR
Practice Address - Street 2:
Practice Address - City:LARKSPUR
Practice Address - State:CA
Practice Address - Zip Code:94939-1105
Practice Address - Country:US
Practice Address - Phone:415-606-6111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-26
Last Update Date:2018-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician