Provider Demographics
NPI:1215744909
Name:BAEZ, GABRIELLA MARCELA
Entity type:Individual
Prefix:
First Name:GABRIELLA
Middle Name:MARCELA
Last Name:BAEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 REDLAND CT STE 101
Mailing Address - Street 2:
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-3291
Mailing Address - Country:US
Mailing Address - Phone:443-364-8099
Mailing Address - Fax:
Practice Address - Street 1:400 REDLAND CT STE 101
Practice Address - Street 2:
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117-3291
Practice Address - Country:US
Practice Address - Phone:443-364-8099
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-16
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP15854101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health