1962461186 NPI number — MS. SYLVIA ANDERSEN HAYDASH L.C.S.W.

Table of content: MS. SYLVIA ANDERSEN HAYDASH L.C.S.W. (NPI 1962461186)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962461186 NPI number — MS. SYLVIA ANDERSEN HAYDASH L.C.S.W.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HAYDASH
Provider First Name:
SYLVIA
Provider Middle Name:
ANDERSEN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
L.C.S.W.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1962461186
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6167 RIVER FOREST DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MANASSAS
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
20112-3047
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-392-7944
Provider Business Mailing Address Fax Number:
703-878-2629

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7502 DIPLOMAT DR
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
MANASSAS
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
20109-2631
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-392-7944
Provider Business Practice Location Address Fax Number:
703-878-2629
Provider Enumeration Date:
03/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  0904004373 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 11526293 . This is a "CAQH" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 8198023 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".




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