Provider Demographics
NPI:1093439937
Name:BALTHASAR, KIEU (LCSW)
Entity Type:Individual
Prefix:
First Name:KIEU
Middle Name:
Last Name:BALTHASAR
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 1:18200 YORBA LINDA BLVD STE 111
Mailing Address - Street 2:
Mailing Address - City:YORBA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92886-4043
Mailing Address - Country:US
Mailing Address - Phone:714-646-8034
Mailing Address - Fax:714-492-8264
Practice Address - Street 1:19742 MACARTHUR BLVD STE 100
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92612-2408
Practice Address - Country:US
Practice Address - Phone:714-646-8034
Practice Address - Fax:714-492-8264
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-03
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA764131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical