Provider Demographics
NPI:1679795561
Name:DALESSIO-BAEZ, ESTERINA (PHD)
Entity type:Individual
Prefix:DR
First Name:ESTERINA
Middle Name:
Last Name:DALESSIO-BAEZ
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 CHESTER STREET
Mailing Address - Street 2:
Mailing Address - City:EAST NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11731
Mailing Address - Country:US
Mailing Address - Phone:631-368-4938
Mailing Address - Fax:
Practice Address - Street 1:554 LARKFIELD RD STE 203
Practice Address - Street 2:
Practice Address - City:EAST NORTHPORT
Practice Address - State:NY
Practice Address - Zip Code:11731-4205
Practice Address - Country:US
Practice Address - Phone:631-368-1571
Practice Address - Fax:631-266-2548
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2019-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015359-01103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist