Provider Demographics
NPI:1437561545
Name:BABAYAN, TATYANA (LSW)
Entity Type:Individual
Prefix:
First Name:TATYANA
Middle Name:
Last Name:BABAYAN
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:193 PINEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10306
Mailing Address - Country:US
Mailing Address - Phone:718-351-3991
Mailing Address - Fax:718-987-5672
Practice Address - Street 1:521 FRANKLIN AVE
Practice Address - Street 2:
Practice Address - City:NUTLEY
Practice Address - State:NJ
Practice Address - Zip Code:07110-1746
Practice Address - Country:US
Practice Address - Phone:973-800-6291
Practice Address - Fax:973-542-8320
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-22
Last Update Date:2016-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC057095001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical