Healthcare Provider Details

I. General information

NPI: 1629624069
Provider Name (Legal Business Name): DALILA BAIED LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2019
Last Update Date: 01/02/2025
Certification Date: 01/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1109 KENTUCKY ST NE
ALBUQUERQUE NM
87110-6923
US

IV. Provider business mailing address

1109 KENTUCKY ST NE
ALBUQUERQUE NM
87110-6923
US

V. Phone/Fax

Practice location:
  • Phone: 505-555-5555
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: