Provider Demographics
NPI:1285391060
Name:BAERGA, KIACHALIZ
Entity type:Individual
Prefix:
First Name:KIACHALIZ
Middle Name:
Last Name:BAERGA
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 1:2280 OLINVILLE AVE APT 903
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10467-7809
Mailing Address - Country:US
Mailing Address - Phone:646-515-0806
Mailing Address - Fax:
Practice Address - Street 1:30 S BROADWAY FL 4
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10701-3708
Practice Address - Country:US
Practice Address - Phone:914-968-5464
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-29
Last Update Date:2022-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst