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General NPI Number Information
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NPI Number | 1992511059
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Entity Type | Individual
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Provider Name | AYANNA BATES LSW
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Gender | Female
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Dates
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Enumeration Date | 12/04/2024
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Last Update Date | 12/04/2024
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Provider Practice Location Address
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Address Line | 19910 MALVERN RD
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City | SHAKER HEIGHTS
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State | OH
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Zip | 44122-2823
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Country | US
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Telephone | 216-544-1321
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Fax |
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Provider Business Mailing Address
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Address Line | 16106 HORACE HARDING EXPY # 2F
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City | FRESH MEADOWS
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State | NY
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Zip | 11365-1856
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Country | US
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Telephone | 347-517-9854
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 123755
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License Number State | NY
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