Provider Demographics
NPI:1629819065
Name:BAEZ, LINA (MS ED)
Entity type:Individual
Prefix:
First Name:LINA
Middle Name:
Last Name:BAEZ
Suffix:
Gender:F
Credentials:MS ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 S PINEHURST AVE APT 4G
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10033-6635
Mailing Address - Country:US
Mailing Address - Phone:646-831-9435
Mailing Address - Fax:
Practice Address - Street 1:4 S PINEHURST AVE APT 4G
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10033-6635
Practice Address - Country:US
Practice Address - Phone:646-831-9435
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-31
Last Update Date:2024-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1212341174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty