Provider Demographics
NPI:1750837308
Name:BAUTISTA, DORKA M (BA, MA)
Entity Type:Individual
Prefix:
First Name:DORKA
Middle Name:M
Last Name:BAUTISTA
Suffix:
Gender:F
Credentials:BA, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3010 GRAND CONCOURSE
Mailing Address - Street 2:APT. 3K
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10458-1511
Mailing Address - Country:US
Mailing Address - Phone:646-639-8829
Mailing Address - Fax:
Practice Address - Street 1:3010 GRAND CONCOURSE
Practice Address - Street 2:APT. 3K
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10458-1511
Practice Address - Country:US
Practice Address - Phone:646-639-8829
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-01
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst