Provider Demographics
NPI:1316286230
Name:DEBORAH HAYNOR PSYCHOTHERAPY AND COLLABORATION LLC
Entity type:Organization
Organization Name:DEBORAH HAYNOR PSYCHOTHERAPY AND COLLABORATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:HAYNOR
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:617-876-4488
Mailing Address - Street 1:186 1/2 HAMPSHIRE STREET
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02139-3187
Mailing Address - Country:US
Mailing Address - Phone:617-876-4488
Mailing Address - Fax:617-876-0350
Practice Address - Street 1:186 1/2 HAMPSHIRE STREET
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02139-3187
Practice Address - Country:US
Practice Address - Phone:617-876-4488
Practice Address - Fax:617-876-0350
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-13
Last Update Date:2013-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1025231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAPO1970Medicare UPIN