Provider Demographics
NPI:1194209296
Name:MONROE-BACKUS, CHEYENNE E (LCSW)
Entity Type:Individual
Prefix:MS
First Name:CHEYENNE
Middle Name:E
Last Name:MONROE-BACKUS
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 1:2801 SCHLEY AVE APT 6C
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10465-2713
Mailing Address - Country:US
Mailing Address - Phone:347-818-0851
Mailing Address - Fax:
Practice Address - Street 1:30 NIGHTINGALE RD BLDG 5513
Practice Address - Street 2:
Practice Address - City:EDWARDS
Practice Address - State:CA
Practice Address - Zip Code:93524-1022
Practice Address - Country:US
Practice Address - Phone:661-277-5291
Practice Address - Fax:661-277-6327
Is Sole Proprietor?:No
Enumeration Date:2018-09-24
Last Update Date:2023-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY104564101Y00000X, 104100000X
NY35052101YA0400X
HI48261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No104100000XBehavioral Health & Social Service ProvidersSocial Worker