Provider Demographics
NPI:1992511059
Name:BATES, AYANNA (LSW)
Entity type:Individual
Prefix:
First Name:AYANNA
Middle Name:
Last Name:BATES
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16106 HORACE HARDING EXPY # 2F
Mailing Address - Street 2:
Mailing Address - City:FRESH MEADOWS
Mailing Address - State:NY
Mailing Address - Zip Code:11365-1856
Mailing Address - Country:US
Mailing Address - Phone:347-517-9854
Mailing Address - Fax:
Practice Address - Street 1:19910 MALVERN RD
Practice Address - Street 2:
Practice Address - City:SHAKER HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44122-2823
Practice Address - Country:US
Practice Address - Phone:216-544-1321
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-04
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1237551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical