Provider Demographics
NPI:1558741595
Name:BAEZ, INDIRA (MED)
Entity Type:Individual
Prefix:
First Name:INDIRA
Middle Name:
Last Name:BAEZ
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50B PARK ST
Mailing Address - Street 2:
Mailing Address - City:DORCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:02122-2611
Mailing Address - Country:US
Mailing Address - Phone:617-822-4807
Mailing Address - Fax:
Practice Address - Street 1:50B PARK ST
Practice Address - Street 2:
Practice Address - City:DORCHESTER
Practice Address - State:MA
Practice Address - Zip Code:02122-2611
Practice Address - Country:US
Practice Address - Phone:617-822-4807
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-04
Last Update Date:2015-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health