Provider Demographics
NPI:1023020203
Name:PERR BAKER, ABBY S (LCSW)
Entity Type:Individual
Prefix:MS
First Name:ABBY
Middle Name:S
Last Name:PERR BAKER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20045 GLEN ARBOR CT
Mailing Address - Street 2:
Mailing Address - City:SARATOGA
Mailing Address - State:CA
Mailing Address - Zip Code:95070-3840
Mailing Address - Country:US
Mailing Address - Phone:408-868-9787
Mailing Address - Fax:408-868-9787
Practice Address - Street 1:20432 SILVERADO AVE
Practice Address - Street 2:SUITE 214
Practice Address - City:CUPERTINO
Practice Address - State:CA
Practice Address - Zip Code:95014-4454
Practice Address - Country:US
Practice Address - Phone:408-868-9787
Practice Address - Fax:408-868-9787
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW #012038101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
R37103Medicare UPIN