Basic Information
Provider Information
NPI: 1912117102
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HYNES
FirstName: ZOYA
MiddleName: K
NamePrefix:  
NameSuffix:  
Credential: L.M.F.T.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1931 CENTER ST
Address2:  
City: BERKELEY
State: CA
PostalCode: 947041105
CountryCode: US
TelephoneNumber: 5106669552
FaxNumber: 5106660987
Practice Location
Address1: 1931 CENTER ST
Address2:  
City: BERKELEY
State: CA
PostalCode: 947041105
CountryCode: US
TelephoneNumber: 5106669552
FaxNumber: 5106660987
Other Information
ProviderEnumerationDate: 05/23/2007
LastUpdateDate: 09/24/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
106H00000X46017CAY Behavioral Health & Social Service ProvidersMarriage & Family Therapist 

No ID Information.


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