Provider Demographics
NPI:1417673609
Name:BAKER- STEWART, COLIS REANESHA (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:COLIS
Middle Name:REANESHA
Last Name:BAKER- STEWART
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:MRS
Other - First Name:COLIS
Other - Middle Name:REANESHA
Other - Last Name:PAYEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMSW
Mailing Address - Street 1:18232 143RD AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11413-3015
Mailing Address - Country:US
Mailing Address - Phone:929-238-5895
Mailing Address - Fax:
Practice Address - Street 1:18232 143RD AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD GARDENS
Practice Address - State:NY
Practice Address - Zip Code:11413-3015
Practice Address - Country:US
Practice Address - Phone:929-238-5895
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-18
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY105259104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty