Provider Demographics
NPI:1457484263
Name:BAIDES, THERESA L (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:THERESA
Middle Name:L
Last Name:BAIDES
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 1:190 S ORCHARD AVE
Mailing Address - Street 2:STE C230
Mailing Address - City:VACAVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95688-3657
Mailing Address - Country:US
Mailing Address - Phone:707-454-0641
Mailing Address - Fax:707-864-1308
Practice Address - Street 1:190 S ORCHARD AVE
Practice Address - Street 2:STE C230
Practice Address - City:VACAVILLE
Practice Address - State:CA
Practice Address - Zip Code:95688-3657
Practice Address - Country:US
Practice Address - Phone:707-454-0641
Practice Address - Fax:707-864-1308
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2019-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS191031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical