Provider Demographics
NPI:1700186301
Name:BAEZA, MARIA (SLP)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:BAEZA
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:EUGENIA
Other - Last Name:BAEZA-DE LA ROSA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:SLP
Mailing Address - Street 1:155 GARTH RD
Mailing Address - Street 2:APT. 4B
Mailing Address - City:SCARSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10583-3858
Mailing Address - Country:US
Mailing Address - Phone:914-574-5736
Mailing Address - Fax:
Practice Address - Street 1:155 GARTH RD
Practice Address - Street 2:APT. 4B
Practice Address - City:SCARSDALE
Practice Address - State:NY
Practice Address - Zip Code:10583-3858
Practice Address - Country:US
Practice Address - Phone:914-574-5736
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-28
Last Update Date:2010-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019840-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist