Provider Demographics
NPI:1124561345
Name:BAEZ, CARMEN E (LCSW)
Entity Type:Individual
Prefix:
First Name:CARMEN
Middle Name:E
Last Name:BAEZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:CARMEN
Other - Middle Name:E
Other - Last Name:PARRILLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:1235 35TH AVE APT 2A
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11106-4738
Mailing Address - Country:US
Mailing Address - Phone:718-419-9507
Mailing Address - Fax:
Practice Address - Street 1:1235 35TH AVE APT 2A
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11106-4738
Practice Address - Country:US
Practice Address - Phone:718-419-9507
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-19
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY093403104100000X
NY0891551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY093403Medicaid
NY06768487Medicaid