=====================================================
General NPI Number Information
=====================================================
NPI Number | 1861638058
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CINDY MARIA BAUTISTA-THOMAS LCSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/18/2008
-----------------------------------------------------
Last Update Date | 01/27/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 36 HUNTER PLACE
-----------------------------------------------------
City | STONY POINT
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10980
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 347-512-5298
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 36 HUNTER PLACE
-----------------------------------------------------
City | STONY POINT
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10980
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 347-512-5298
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number | 076404
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1041S0200X
-----------------------------------------------------
Taxonomy Name | School Social Worker
-----------------------------------------------------
License Number | 076404
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 076404
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------