Provider Demographics
NPI:1225102130
Name:BAEZ, LISA LORRAINE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:LORRAINE
Last Name:BAEZ
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 1:16689 SWIFT FOX AVE
Mailing Address - Street 2:
Mailing Address - City:CHINO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91709-7999
Mailing Address - Country:US
Mailing Address - Phone:909-606-3019
Mailing Address - Fax:909-606-3019
Practice Address - Street 1:219 N INDIAN HILL BLVD
Practice Address - Street 2:SUITE 205
Practice Address - City:CLAREMONT
Practice Address - State:CA
Practice Address - Zip Code:91711-4644
Practice Address - Country:US
Practice Address - Phone:909-548-9957
Practice Address - Fax:909-606-3019
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS196211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical