Individual
JEFFREY HAYNES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LADC
Contact information
Practice address
1 LONG WHARF DR, NEW HAVEN, CT 06511-5946
(203) 781-4600
(203) 781-4624
Mailing address
1 LONG WHARF DR, NEW HAVEN, CT 06511-5946
(203) 781-4600
(203) 781-4624
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
000874
CT
101YM0800X
Mental Health Counselor
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004082286
—
CT
05
—
008022626
—
CT
01
—
008050283
MEDICAID (HAYNES)
CT
05
—
500000315
—
CT
Enumeration date
03/21/2007
Last updated
01/24/2022
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