Provider Demographics
NPI:1336960236
Name:HAIMES, AMY L
Entity type:Individual
Prefix:DR
First Name:AMY
Middle Name:L
Last Name:HAIMES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:L
Other - Last Name:HAIMES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:24 EDGEWATER PLACE
Mailing Address - Street 2:UNIT 406
Mailing Address - City:BEACON
Mailing Address - State:NY
Mailing Address - Zip Code:12508
Mailing Address - Country:US
Mailing Address - Phone:917-748-5481
Mailing Address - Fax:
Practice Address - Street 1:24 EDGEWATER PLACE
Practice Address - Street 2:UNIT #406
Practice Address - City:BEACON
Practice Address - State:NY
Practice Address - Zip Code:12508
Practice Address - Country:US
Practice Address - Phone:917-748-5481
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-23
Last Update Date:2024-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008858-01103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical