Healthcare Provider Details

I. General information

NPI: 1972836930
Provider Name (Legal Business Name): FREDDY BAEZ L.C.S.W.-R
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2009
Last Update Date: 12/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1505 PELHAM PKWY N 1 FLOOR
BRONX NY
10469-5912
US

IV. Provider business mailing address

1505 PELHAM PKWY N 1 FLOOR
BRONX NY
10469-5912
US

V. Phone/Fax

Practice location:
  • Phone: 917-685-1846
  • Fax:
Mailing address:
  • Phone: 917-685-1846
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number041291
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: