Provider Demographics
NPI:1083048771
Name:BAEZ, KATE WELTON (RBT, LMFT)
Entity Type:Individual
Prefix:MRS
First Name:KATE
Middle Name:WELTON
Last Name:BAEZ
Suffix:
Gender:F
Credentials:RBT, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3512 POPPY CRES
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23453-2210
Mailing Address - Country:US
Mailing Address - Phone:908-966-8121
Mailing Address - Fax:
Practice Address - Street 1:708 S ROSEMONT RD
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-4061
Practice Address - Country:US
Practice Address - Phone:757-731-0105
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-29
Last Update Date:2018-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106H00000X
VA0717001462106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist