Provider Demographics
NPI:1871021378
Name:BAEZ, GINA (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:GINA
Middle Name:
Last Name:BAEZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:GINA
Other - Middle Name:
Other - Last Name:LIMA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:92-1202 OLANI ST
Mailing Address - Street 2:
Mailing Address - City:KAPOLEI
Mailing Address - State:HI
Mailing Address - Zip Code:96707-4265
Mailing Address - Country:US
Mailing Address - Phone:253-861-7182
Mailing Address - Fax:
Practice Address - Street 1:92-1202 OLANI ST
Practice Address - Street 2:
Practice Address - City:KAPOLEI
Practice Address - State:HI
Practice Address - Zip Code:96707-4265
Practice Address - Country:US
Practice Address - Phone:253-861-7182
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI44261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical