MEDICARE: MRS. ANNALISA CHRISTINA BAEZ LMHC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor
2	101YM0800X	Mental Health Counselor	MH15903	FL

General Provider Information

NPI Number	:	1730408782
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ANNALISA CHRISTINA BAEZ LMHC

Provider Business Mailing Address
First Line	:	6710 EMBASSY BLVD STE 208
Second Line	:
City	:	PORT RICHEY
State	:	FL
Zip	:	34668-4738
Country	:	US
Telephone Number	:	727-819-4257
Fax Number	:

Provider Business Practice Location Address
First Line	:	6710 EMBASSY BLVD STE 208
Second Line	:
City	:	PORT RICHEY
State	:	FL
Zip	:	34668-4738
Country	:	US
Telephone Number	:	727-819-4257
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/28/2010
Last Update Date	:	11/07/2023

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