Healthcare Provider Details

I. General information

NPI: 1629932421
Provider Name (Legal Business Name): BAKEISHIA CLEVELAND
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 W 60TH ST FL 5B
NEW YORK NY
10023-7905
US

IV. Provider business mailing address

33 W 60TH ST FL 6
NEW YORK NY
10023-7905
US

V. Phone/Fax

Practice location:
  • Phone: 917-870-9330
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number12713601
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: