Provider Demographics
NPI:1619855905
Name:LUCERO BAEZA, TRISHA MARIE (PPSC, LCSW)
Entity type:Individual
Prefix:
First Name:TRISHA
Middle Name:MARIE
Last Name:LUCERO BAEZA
Suffix:
Gender:F
Credentials:PPSC, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2011 FRESNO ST
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93721-1722
Mailing Address - Country:US
Mailing Address - Phone:559-248-7310
Mailing Address - Fax:
Practice Address - Street 1:4524 N THORNE AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93704-3519
Practice Address - Country:US
Practice Address - Phone:559-248-7310
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-25
Last Update Date:2025-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1202941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical