Provider Demographics
NPI:1336544121
Name:BAIZA, MARLEN (MHC)
Entity Type:Individual
Prefix:
First Name:MARLEN
Middle Name:
Last Name:BAIZA
Suffix:
Gender:F
Credentials:MHC
Other - Prefix:
Other - First Name:MARLEN
Other - Middle Name:
Other - Last Name:BAIZA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MNC
Mailing Address - Street 1:9511 PITKIN AVE
Mailing Address - Street 2:
Mailing Address - City:OZONE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11417-2833
Mailing Address - Country:US
Mailing Address - Phone:305-904-1388
Mailing Address - Fax:
Practice Address - Street 1:9511 PITKIN AVE
Practice Address - Street 2:
Practice Address - City:OZONE PARK
Practice Address - State:NY
Practice Address - Zip Code:11417-2833
Practice Address - Country:US
Practice Address - Phone:305-904-1388
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-23
Last Update Date:2014-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health