Provider Demographics
NPI:1083731574
Name:BALTIMORE, SUSAN CHERYL (LCSW)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:CHERYL
Last Name:BALTIMORE
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 1:1000 W CARSON ST
Mailing Address - Street 2:BUILDING 1-SOUTH
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90502-2004
Mailing Address - Country:US
Mailing Address - Phone:310-222-7942
Mailing Address - Fax:310-212-7609
Practice Address - Street 1:1000 W CARSON ST
Practice Address - Street 2:BUILDING 1-SOUTH
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90502-2004
Practice Address - Country:US
Practice Address - Phone:310-222-7942
Practice Address - Fax:310-212-7609
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 9118251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health