Healthcare Provider Details

I. General information

NPI: 1578479143
Provider Name (Legal Business Name): CHASTITY BAEDER ACSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2026
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

421 N BROOKHURST ST STE 119
ANAHEIM CA
92801-5618
US

IV. Provider business mailing address

555 N EL CAMINO REAL # A258
SAN CLEMENTE CA
92672-6740
US

V. Phone/Fax

Practice location:
  • Phone: 714-361-0898
  • Fax: 714-276-2604
Mailing address:
  • Phone: 562-332-4660
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number142109
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: