Sydney Haynes, LCSW
Individual provider Active NPI Clinical Social Worker · Willow Creek, CA
NPI 1376000646 · NPPES record last updated Nov 18, 2024
Key facts
- NPI
- 1376000646
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Social Worker 1041C0700X
- License
- LCSW104076 (CA)
- Practice address
- 49 Fireway Lane
Willow Creek, CA 95573-0724 - Phone
- (541) 292-6021
- NPI assigned
- Feb 22, 2019
- Sex
- Female
- Sole proprietor
- Yes
Medicare Care Compare profile
- Specialty
- Clinical Social Worker
- Education
- Other, 2017
- Medicare assignment
- May accept Medicare assignment
- Telehealth
- Offers telehealth services
Practice addresses (Care Compare)
49 Fireway Lane
Willow Creek, CA 95573
Phone (541) 292-6021
PO Box
Suite 724
Willow Creek, CA 95573
PO Box
Suite 724
Willow Creek, CA 95573-0724
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20241004000332 | CA | Practitioner - Clinical Social Worker | 2860843364 | Practice locations: Willow Creek, CA |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LCSW104076 | CA | MD | Clinical Social Worker |
| 104076 | CA | MD | Marriage & Family Therapist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | LCSW104076 | CA | Yes |
Addresses
Primary practice location
49 Fireway Lane
Willow Creek, CA 95573-0724
Mailing address
PO Box 724
Willow Creek, CA 95573-0724
Phone (541) 292-6021
Other practice location 1
57 Walnut Way
Willow creek, CA 95573
Phone (541) 292-6021
Other providers in Willow Creek, CA
- Suzanne Garrett
- Mary Genoar
- Irene Graham
- John L Greenwood
- Roland N Grubb
- Shari Rachelle Hostler
- Humboldt County Behavioral Health
- Humboldt Radiology Medical Group Inc
- Amanda Baer James
- William O. Jones
All providers in Willow Creek, CA · Clinical Social Worker in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 18, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.