Provider Demographics
NPI:1942697768
Name:HALEY, DINO (LMSW)
Entity type:Individual
Prefix:
First Name:DINO
Middle Name:
Last Name:HALEY
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8568 W OCOTILLO RD
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85305-2178
Mailing Address - Country:US
Mailing Address - Phone:602-228-3710
Mailing Address - Fax:
Practice Address - Street 1:8568 W OCOTILLO RD
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85305-2178
Practice Address - Country:US
Practice Address - Phone:602-228-3710
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-20
Last Update Date:2015-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLMSW-13550104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZLMSW-13550OtherLICENSED MASTER SOCIAL WORKER