Provider Demographics
NPI:1376003319
Name:BAEZ, MITZIE JAZMIN (MA, LMFT, CCTP)
Entity Type:Individual
Prefix:
First Name:MITZIE
Middle Name:JAZMIN
Last Name:BAEZ
Suffix:
Gender:F
Credentials:MA, LMFT, CCTP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 N PRINCE ST
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17603-3010
Mailing Address - Country:US
Mailing Address - Phone:717-560-7919
Mailing Address - Fax:717-560-6452
Practice Address - Street 1:15 S 9TH ST
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:PA
Practice Address - Zip Code:17042-5104
Practice Address - Country:US
Practice Address - Phone:717-273-5992
Practice Address - Fax:717-273-5995
Is Sole Proprietor?:No
Enumeration Date:2019-03-25
Last Update Date:2019-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMF001056106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist