=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346391307
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | GINA JEAN BAPTISTE L.C.S.W
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/16/2007
-----------------------------------------------------
Last Update Date | 07/16/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 39 BROADWAY RM 1140
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10006-3105
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 646-790-2449
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 114 FENIMORE ST APT 1C
-----------------------------------------------------
City | BROOKLYN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11225-5323
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 347-529-3921
-----------------------------------------------------
Fax | 917-553-6902
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 073530
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------