Provider Demographics
NPI:1699894998
Name:HAINES-BURNHAM, JAMES LEONARD (LCSW-R)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:LEONARD
Last Name:HAINES-BURNHAM
Suffix:
Gender:M
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:512 UTICA ST
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-3642
Mailing Address - Country:US
Mailing Address - Phone:607-342-6219
Mailing Address - Fax:
Practice Address - Street 1:415 N TIOGA ST
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-4228
Practice Address - Country:US
Practice Address - Phone:607-342-6219
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0615041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical