Provider Demographics
NPI:1457597718
Name:BAENA, LUZ MARIA (MS, LCSW)
Entity Type:Individual
Prefix:MRS
First Name:LUZ
Middle Name:MARIA
Last Name:BAENA
Suffix:
Gender:F
Credentials:MS, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:195 E BEVERLY PKWY
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11580-4247
Mailing Address - Country:US
Mailing Address - Phone:516-872-4062
Mailing Address - Fax:
Practice Address - Street 1:195 E BEVERLY PKWY
Practice Address - Street 2:
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11580-4247
Practice Address - Country:US
Practice Address - Phone:516-872-4062
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-16
Last Update Date:2008-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY222455031SP.ED.TECH171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor