Provider Demographics
NPI:1750847323
Name:BAUTISTA, LAYRA
Entity Type:Individual
Prefix:
First Name:LAYRA
Middle Name:
Last Name:BAUTISTA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:466 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10801-6431
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:503 GRASSLANDS RD STE 101
Practice Address - Street 2:
Practice Address - City:VALHALLA
Practice Address - State:NY
Practice Address - Zip Code:10595-1520
Practice Address - Country:US
Practice Address - Phone:914-593-0593
Practice Address - Fax:914-593-0594
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-19
Last Update Date:2021-06-03
Deactivation Date:2019-05-28
Deactivation Code:
Reactivation Date:2021-05-25
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician