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General NPI Number Information
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NPI Number | 1083781421
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Entity Type | Individual
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Provider Name | CORLISS MARGARET BACA LCSW
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Gender | Female
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Dates
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Enumeration Date | 11/29/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2901 MEADOW LARK DR
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City | SAN DIEGO
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State | CA
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Zip | 92123-2711
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Country | US
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Telephone | 858-541-5244
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Fax | 858-541-5221
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Provider Business Mailing Address
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Address Line | 1575 SUNSET CLIFFS BLVD
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City | SAN DIEGO
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State | CA
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Zip | 92107-3433
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Country | US
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Telephone | 619-222-0048
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Fax | 858-541-5244
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 10653
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License Number State | CA
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