Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | 114669 | CA |
NPI | 1083218804 |
---|---|
Provider Name | Judith Ann Bensinger Haynes |
First Address | Lafayette, CA 94549-3418 |
Second Address | Lafayette, CA 94549-3418 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/11/2020 |
Last Update Date | 23/11/2020 |