Provider Demographics
NPI:1073729315
Name:BAEZ-CHAVEZ, MARY M (LCSW)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:M
Last Name:BAEZ-CHAVEZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5505 GRISSOM RD STE 128
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78238-3038
Mailing Address - Country:US
Mailing Address - Phone:210-415-1209
Mailing Address - Fax:
Practice Address - Street 1:5505 GRISSOM RD STE 128
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78238-3038
Practice Address - Country:US
Practice Address - Phone:210-415-1209
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2009-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX278231041C0700X, 171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No171M00000XOther Service ProvidersCase Manager/Care Coordinator