Provider Demographics
NPI:1740599851
Name:BAEZ, DAVIDSON WILFREDO (MA)
Entity Type:Individual
Prefix:MR
First Name:DAVIDSON
Middle Name:WILFREDO
Last Name:BAEZ
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 PARK AVE STE 500
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01609-1958
Mailing Address - Country:US
Mailing Address - Phone:508-753-2900
Mailing Address - Fax:
Practice Address - Street 1:255 PARK AVE STE 500
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01609-1958
Practice Address - Country:US
Practice Address - Phone:508-753-2900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2722103TC1900X
101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling