Provider Demographics
NPI:1962716662
Name:BAEZ-SACASA, VANESSA (LCSW-R)
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:
Last Name:BAEZ-SACASA
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 SOUTH AVE
Mailing Address - Street 2:SUITE LL2
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-3430
Mailing Address - Country:US
Mailing Address - Phone:718-477-0961
Mailing Address - Fax:718-761-1643
Practice Address - Street 1:1000 SOUTH AVE
Practice Address - Street 2:SUITE LL2
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-3430
Practice Address - Country:US
Practice Address - Phone:718-477-0961
Practice Address - Fax:718-761-1643
Is Sole Proprietor?:No
Enumeration Date:2010-08-05
Last Update Date:2010-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0640321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical