Provider Demographics
NPI:1629066345
Name:BAFFA, ARLENE JUNE (LCSW-R)
Entity Type:Individual
Prefix:MRS
First Name:ARLENE
Middle Name:JUNE
Last Name:BAFFA
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 BALSAM DR
Mailing Address - Street 2:
Mailing Address - City:DIX HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11746-7725
Mailing Address - Country:US
Mailing Address - Phone:631-421-9104
Mailing Address - Fax:
Practice Address - Street 1:50 BALSAM DR
Practice Address - Street 2:
Practice Address - City:DIX HILLS
Practice Address - State:NY
Practice Address - Zip Code:11746-7725
Practice Address - Country:US
Practice Address - Phone:631-421-9104
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-06
Last Update Date:2007-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR014192-11041C0700X
NY1041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01493278Medicaid
NYN3I721Medicare ID - Type Unspecified