Provider Demographics
NPI:1003062381
Name:BAKER, LIZA
Entity Type:Individual
Prefix:
First Name:LIZA
Middle Name:
Last Name:BAKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LIZA
Other - Middle Name:
Other - Last Name:BRODY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:94-216 FARRINGTON HWY
Mailing Address - Street 2:
Mailing Address - City:WAIPAHU
Mailing Address - State:HI
Mailing Address - Zip Code:96797-1922
Mailing Address - Country:US
Mailing Address - Phone:808-589-1829
Mailing Address - Fax:808-589-2610
Practice Address - Street 1:94-216 FARRINGTON HWY
Practice Address - Street 2:
Practice Address - City:WAIPAHU
Practice Address - State:HI
Practice Address - Zip Code:96797-1922
Practice Address - Country:US
Practice Address - Phone:808-589-1829
Practice Address - Fax:808-589-2610
Is Sole Proprietor?:No
Enumeration Date:2008-08-18
Last Update Date:2008-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist