Provider Demographics
NPI:1881340263
Name:BAEZ LAKE, EIMY I
Entity type:Individual
Prefix:
First Name:EIMY
Middle Name:I
Last Name:BAEZ LAKE
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 1:1 GUSTAVE L. LEVY PLACE, NEW YORK, NY 10029
Mailing Address - Street 2:
Mailing Address - City:NY
Mailing Address - State:NY
Mailing Address - Zip Code:10029
Mailing Address - Country:US
Mailing Address - Phone:917-886-7624
Mailing Address - Fax:
Practice Address - Street 1:1 GUSTAVE L. LEVY PLACE, NEW YORK
Practice Address - Street 2:1 GUSTAVE L. LEVY PLACE, NEW YORK, NY 10029
Practice Address - City:NY
Practice Address - State:NY
Practice Address - Zip Code:10029
Practice Address - Country:US
Practice Address - Phone:917-886-7624
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-24
Last Update Date:2022-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY113869104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker