Provider Demographics
NPI:1972836930
Name:BAEZ, FREDDY (LCSW-R)
Entity type:Individual
Prefix:MR
First Name:FREDDY
Middle Name:
Last Name:BAEZ
Suffix:
Gender:M
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 1:1505 PELHAM PKWY N
Mailing Address - Street 2:1 FLOOR
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10469-5912
Mailing Address - Country:US
Mailing Address - Phone:917-685-1846
Mailing Address - Fax:
Practice Address - Street 1:1505 PELHAM PKWY N
Practice Address - Street 2:1 FLOOR
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10469-5912
Practice Address - Country:US
Practice Address - Phone:917-685-1846
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-09
Last Update Date:2015-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP1600X
NY0412911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral