Individual
MS. KETTY ALEXANDRIA BAALLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
B.A.
Contact information
Practice address
80 E END AVE, CLARKE SCHOOL NEW YORK, NEW YORK, NY 10028-8004
(212) 585-3500
Mailing address
80 E END AVE, CLARKE SCHOOL NEW YORK, NEW YORK, NY 10028-8004
(212) 585-3500
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
16757
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
16757
SERVICE COORDINATION ID
NY
Enumeration date
06/26/2012
Last updated
06/26/2012
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