Healthcare Provider Details

I. General information

NPI: 1972417186
Provider Name (Legal Business Name): FATUMATA BAH I
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2026
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6214 RIVERDALE AVE STE 1A
BRONX NY
10471-1032
US

IV. Provider business mailing address

77 SULLIVAN PL APT 3A
BROOKLYN NY
11225-2521
US

V. Phone/Fax

Practice location:
  • Phone: 718-701-4807
  • Fax:
Mailing address:
  • Phone: 929-326-5921
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number133586
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: