Provider Demographics
NPI:1508100629
Name:BAUTISTA, NANCY IVETTE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:NANCY
Middle Name:IVETTE
Last Name:BAUTISTA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1818 W BEVERLY BLVD STE 207
Mailing Address - Street 2:
Mailing Address - City:MONTEBELLO
Mailing Address - State:CA
Mailing Address - Zip Code:90640-3968
Mailing Address - Country:US
Mailing Address - Phone:562-385-5532
Mailing Address - Fax:
Practice Address - Street 1:1818 W BEVERLY BLVD STE 207
Practice Address - Street 2:
Practice Address - City:MONTEBELLO
Practice Address - State:CA
Practice Address - Zip Code:90640-3968
Practice Address - Country:US
Practice Address - Phone:562-385-5532
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-15
Last Update Date:2022-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA794001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical