Provider Demographics
NPI:1992341812
Name:BAQUERO, CALLIE (LMFT)
Entity type:Individual
Prefix:MRS
First Name:CALLIE
Middle Name:
Last Name:BAQUERO
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 PURDY AVE APT 2008
Mailing Address - Street 2:
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33139-1459
Mailing Address - Country:US
Mailing Address - Phone:305-495-2506
Mailing Address - Fax:
Practice Address - Street 1:2000 S DIXIE HWY STE 104
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33133-2441
Practice Address - Country:US
Practice Address - Phone:305-495-2506
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-26
Last Update Date:2019-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT3738106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist