Healthcare Provider Details

I. General information

NPI: 1437561545
Provider Name (Legal Business Name): TATYANA BABAYAN LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2014
Last Update Date: 11/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

521 FRANKLIN AVE
NUTLEY NJ
07110-1746
US

IV. Provider business mailing address

193 PINEWOOD AVE
STATEN ISLAND NY
10306
US

V. Phone/Fax

Practice location:
  • Phone: 973-800-6291
  • Fax: 973-542-8320
Mailing address:
  • Phone: 718-351-3991
  • Fax: 718-987-5672

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC05709500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: