Provider Demographics
NPI:1649704982
Name:BAEZ, MARIE AUSTERLYN
Entity type:Individual
Prefix:MRS
First Name:MARIE
Middle Name:AUSTERLYN
Last Name:BAEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:MARIE
Other - Middle Name:AUSTERLYN
Other - Last Name:BAEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC, LMHC, NCC, ACS
Mailing Address - Street 1:466 HACKENSACK AVE # 1024
Mailing Address - Street 2:
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-6305
Mailing Address - Country:US
Mailing Address - Phone:201-771-1514
Mailing Address - Fax:201-431-1113
Practice Address - Street 1:11189 PRAIRIE HAWK DRIVE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32837
Practice Address - Country:US
Practice Address - Phone:201-771-1514
Practice Address - Fax:201-431-1113
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-13
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X, 106H00000X, 101YS0200X, 101YM0800X
FLMH22828101YM0800X
NJ101YM0800X
MALMHC10001357101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool