Provider Demographics
NPI:1689266272
Name:BACZEWSKI, ANIELA THERESE (MA)
Entity Type:Individual
Prefix:
First Name:ANIELA
Middle Name:THERESE
Last Name:BACZEWSKI
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4600 MUELLER BLVD APT 3016
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78723-3375
Mailing Address - Country:US
Mailing Address - Phone:512-657-8009
Mailing Address - Fax:
Practice Address - Street 1:3818 SPICEWOOD SPRINGS RD STE 300
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-8971
Practice Address - Country:US
Practice Address - Phone:512-842-4591
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-05
Last Update Date:2021-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX84885101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
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