Provider Demographics
NPI:1043887888
Name:HAYCOCK, CATHLEEN MARIE LOUISE
Entity type:Individual
Prefix:
First Name:CATHLEEN
Middle Name:MARIE LOUISE
Last Name:HAYCOCK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 W CHAPEL ST
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93458-4303
Mailing Address - Country:US
Mailing Address - Phone:805-922-2243
Mailing Address - Fax:
Practice Address - Street 1:2370 SKYWAY DR STE 104
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93455-1133
Practice Address - Country:US
Practice Address - Phone:805-922-2243
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-09
Last Update Date:2021-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator