Provider Demographics
NPI:1154834307
Name:BAUTA, BESA H
Entity Type:Individual
Prefix:
First Name:BESA
Middle Name:H
Last Name:BAUTA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:241 37TH STREET 6TH FLOOR
Mailing Address - Street 2:BUILDING NO 1
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11232-2420
Mailing Address - Country:US
Mailing Address - Phone:201-679-1631
Mailing Address - Fax:
Practice Address - Street 1:241 37TH ST FL 6TH
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11232-2417
Practice Address - Country:US
Practice Address - Phone:201-679-1631
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-09
Last Update Date:2017-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY073717104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty