Provider Demographics
NPI:1841679040
Name:BAOWAIDAN, LAMIS (MA)
Entity type:Individual
Prefix:MS
First Name:LAMIS
Middle Name:
Last Name:BAOWAIDAN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 716
Mailing Address - Street 2:
Mailing Address - City:PALISADES
Mailing Address - State:NY
Mailing Address - Zip Code:10964-0716
Mailing Address - Country:US
Mailing Address - Phone:845-359-8846
Mailing Address - Fax:
Practice Address - Street 1:680 OAK TREE RD
Practice Address - Street 2:
Practice Address - City:PALISADES
Practice Address - State:NY
Practice Address - Zip Code:10964-1532
Practice Address - Country:US
Practice Address - Phone:845-359-8846
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-21
Last Update Date:2015-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2360578252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency