Provider Demographics
NPI:1043678063
Name:BAEZ, DAISY (MED)
Entity Type:Individual
Prefix:
First Name:DAISY
Middle Name:
Last Name:BAEZ
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:59 NELSON ST APT D
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06120-2041
Mailing Address - Country:US
Mailing Address - Phone:860-888-9112
Mailing Address - Fax:
Practice Address - Street 1:59 NELSON ST
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06120-2041
Practice Address - Country:US
Practice Address - Phone:860-888-9112
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-04
Last Update Date:2016-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)