Provider Demographics
NPI:1316250285
Name:TRAYLOR, CHERIE LEE (LCSW)
Entity type:Individual
Prefix:MS
First Name:CHERIE
Middle Name:LEE
Last Name:TRAYLOR
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:CHERYL
Other - Middle Name:LEE
Other - Last Name:GAIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:3420 KENYON ST
Mailing Address - Street 2:BLDG B, 2ND FLOOR
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92110-5001
Mailing Address - Country:US
Mailing Address - Phone:877-496-0450
Mailing Address - Fax:619-221-6565
Practice Address - Street 1:3420 KENYON ST
Practice Address - Street 2:BLDG B, 2ND FLOOR
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92110-5001
Practice Address - Country:US
Practice Address - Phone:877-496-0450
Practice Address - Fax:619-221-6565
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-21
Last Update Date:2010-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS72561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical