Provider Demographics
NPI:1821659723
Name:AINSWORTH, CHEYENNE LORRAINE (MSW)
Entity Type:Individual
Prefix:MS
First Name:CHEYENNE
Middle Name:LORRAINE
Last Name:AINSWORTH
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:331 BLUE CORAL CV UNIT 103
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92154-8836
Mailing Address - Country:US
Mailing Address - Phone:516-732-6934
Mailing Address - Fax:
Practice Address - Street 1:331 BLUE CORAL CV UNIT 103
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92154-8836
Practice Address - Country:US
Practice Address - Phone:516-732-6934
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-22
Last Update Date:2019-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty