Provider Demographics
NPI:1447523840
Name:HAYBA, ALICIA RENEE (LISW, IMH-III)
Entity type:Individual
Prefix:MRS
First Name:ALICIA
Middle Name:RENEE
Last Name:HAYBA
Suffix:
Gender:F
Credentials:LISW, IMH-III
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 1090
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88004
Mailing Address - Country:US
Mailing Address - Phone:575-523-2288
Mailing Address - Fax:
Practice Address - Street 1:3050 N ROADRUNNER PKWY
Practice Address - Street 2:STE A,
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-0833
Practice Address - Country:US
Practice Address - Phone:575-523-2288
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-15
Last Update Date:2012-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMI-068611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical