Healthcare Provider Details

I. General information

NPI: 1902743776
Provider Name (Legal Business Name): EVAN BAISLEY LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2026
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 BEAVER ST STE 301
ALBANY NY
12207-1504
US

IV. Provider business mailing address

50 BEAVER ST STE 301
ALBANY NY
12207-1504
US

V. Phone/Fax

Practice location:
  • Phone: 518-245-6272
  • Fax: 518-992-2322
Mailing address:
  • Phone: 518-245-6272
  • Fax: 518-992-2322

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number129496
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: