Provider Demographics
NPI:1528279247
Name:CADNEY-BAUCUM, NINA (LICSW)
Entity type:Individual
Prefix:
First Name:NINA
Middle Name:
Last Name:CADNEY-BAUCUM
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5627 EADS ST NE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20019-6920
Mailing Address - Country:US
Mailing Address - Phone:240-432-1873
Mailing Address - Fax:
Practice Address - Street 1:1100 ALABAMA AVE SE UNIT 1D
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20032-4542
Practice Address - Country:US
Practice Address - Phone:202-657-7495
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2391C1041C0700X
MD135031041C0700X
DCLC500799351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1305Medicaid