Provider Demographics
NPI:1902183965
Name:BAEZ, DAMARIS
Entity Type:Individual
Prefix:
First Name:DAMARIS
Middle Name:
Last Name:BAEZ
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:P.O. BOX 26055
Mailing Address - Street 2:
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33320
Mailing Address - Country:US
Mailing Address - Phone:954-353-9777
Mailing Address - Fax:954-343-3644
Practice Address - Street 1:4987 N UNIVERSITY DRIVE
Practice Address - Street 2:SUITE 20-B
Practice Address - City:LAUDERHILL
Practice Address - State:FL
Practice Address - Zip Code:33351
Practice Address - Country:US
Practice Address - Phone:954-353-9777
Practice Address - Fax:954-343-3644
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-04
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst