Provider Demographics
NPI:1881092559
Name:BAYLIN, MARY YOUNGMAN (LCSW LICENSED CL)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:YOUNGMAN
Last Name:BAYLIN
Suffix:
Gender:F
Credentials:LCSW LICENSED CL
Other - Prefix:MRS
Other - First Name:BETH
Other - Middle Name:Y
Other - Last Name:BAYLIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:204 SAINT JAMES PL
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11238-2302
Mailing Address - Country:US
Mailing Address - Phone:718-687-3790
Mailing Address - Fax:
Practice Address - Street 1:204 SAINT JAMES PL
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11238-2302
Practice Address - Country:US
Practice Address - Phone:718-687-3790
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-12
Last Update Date:2014-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0752071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical