Provider Demographics
NPI:1194847269
Name:BAINES, VERONICA LEIGH (LCSW)
Entity type:Individual
Prefix:MRS
First Name:VERONICA
Middle Name:LEIGH
Last Name:BAINES
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:VERONICA
Other - Middle Name:LEIGH
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2000 W BRIGGSMORE AVE STE I
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95350-3839
Mailing Address - Country:US
Mailing Address - Phone:209-526-1476
Mailing Address - Fax:209-526-0908
Practice Address - Street 1:3432 HILLCREST AVE STE 175
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94531-6343
Practice Address - Country:US
Practice Address - Phone:925-234-3993
Practice Address - Fax:925-634-1145
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2018-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALSC 239561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ZZZ06465ZOtherMEDICARE PROVIDER ID/PTAN