Provider Demographics
NPI:1477754125
Name:BAEZA, CHERYL ANNE (LCSW MSW)
Entity Type:Individual
Prefix:MRS
First Name:CHERYL
Middle Name:ANNE
Last Name:BAEZA
Suffix:
Gender:F
Credentials:LCSW MSW
Other - Prefix:MS
Other - First Name:CHERYL
Other - Middle Name:ANNE
Other - Last Name:CAMPBELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2149 N ACADEMY BLVD
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909-1507
Mailing Address - Country:US
Mailing Address - Phone:719-661-9323
Mailing Address - Fax:719-434-9930
Practice Address - Street 1:2149 N ACADEMY BLVD
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909
Practice Address - Country:US
Practice Address - Phone:719-661-9323
Practice Address - Fax:719-434-9930
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-30
Last Update Date:2020-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAL5100341041C0700X
CO9924091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000148467Medicaid
CO547067Medicaid
CO12158616OtherCAQH