Healthcare Provider Details

I. General information

NPI: 1417436635
Provider Name (Legal Business Name): BRIGITTE BAUTISTA LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2018
Last Update Date: 08/09/2024
Certification Date: 08/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

335 E AVENUE I
LANCASTER CA
93535-1916
US

IV. Provider business mailing address

43111 7TH ST E
LANCASTER CA
93535-4749
US

V. Phone/Fax

Practice location:
  • Phone: 213-465-5197
  • Fax:
Mailing address:
  • Phone: 818-451-6817
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number109700
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number84098
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: