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General NPI Number Information
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NPI Number | 1467648071
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Entity Type | Organization
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Legal Business Name | BEATRIZ BAELLA HERNANDEZ LCSW,PLLC
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Dates
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Enumeration Date | 09/18/2007
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Last Update Date | 04/24/2008
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Provider Practice Location Address
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Address Line | 2888 MAHAN DR SUITE 1
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City | TALLAHASSEE
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State | FL
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Zip | 32308-5464
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Country | US
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Telephone | 850-443-1974
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Fax | 850-422-1923
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Provider Business Mailing Address
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Address Line | 7101 SLEEPY HOLW
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City | TALLAHASSEE
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State | FL
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Zip | 32312-7563
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Country | US
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Telephone | 850-443-1974
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Fax | 850-422-1923
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Authorized Official
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Title or Position | MEMBER MANAGER
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Name | BEATRIZ G. BAELLA HERNANDEZ
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Credential | LCSW
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Telephone | 850-443-1974
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | SW 8676
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License Number State | FL
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