Healthcare Provider Details

I. General information

NPI: 1194209296
Provider Name (Legal Business Name): CHEYENNE E MONROE-BACKUS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2018
Last Update Date: 09/22/2023
Certification Date: 09/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 NIGHTINGALE RD BLDG 5513
EDWARDS CA
93524-1022
US

IV. Provider business mailing address

2801 SCHLEY AVE APT 6C
BRONX NY
10465-2713
US

V. Phone/Fax

Practice location:
  • Phone: 661-277-5291
  • Fax: 661-277-6327
Mailing address:
  • Phone: 347-818-0851
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number104564
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number35052
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number104564
License Number StateNY
# 4
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number4826
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: