Provider Demographics
NPI:1003996372
Name:BAKER, REBECCA E (MSW)
Entity Type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:E
Last Name:BAKER
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:MS
Other - First Name:BECKY
Other - Middle Name:
Other - Last Name:READ-BAKER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2579 WESTERN TRAILS BLVD
Mailing Address - Street 2:STE.#200
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78745-1688
Mailing Address - Country:US
Mailing Address - Phone:512-899-3933
Mailing Address - Fax:512-899-3576
Practice Address - Street 1:2579 WESTERN TRAILS BLVD
Practice Address - Street 2:STE.#200
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78745-1688
Practice Address - Country:US
Practice Address - Phone:512-899-3933
Practice Address - Fax:512-899-3576
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX036651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX610556Medicare ID - Type Unspecified