Provider Demographics
NPI:1497531701
Name:BACCALA, DORIS ANGELICA (LMSW)
Entity Type:Individual
Prefix:
First Name:DORIS
Middle Name:ANGELICA
Last Name:BACCALA
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:DORIS
Other - Middle Name:A
Other - Last Name:ROMERO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 890895
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73189-0895
Mailing Address - Country:US
Mailing Address - Phone:405-605-8488
Mailing Address - Fax:888-877-9894
Practice Address - Street 1:5350 S WESTERN AVE STE 215
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73109-4525
Practice Address - Country:US
Practice Address - Phone:405-605-8488
Practice Address - Fax:888-877-9894
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-01
Last Update Date:2023-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK20377104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker