Provider Demographics
NPI:1043406374
Name:BAKER, AMANDA R (MED, LCPC)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:R
Last Name:BAKER
Suffix:
Gender:F
Credentials:MED, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 936
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04402-0936
Mailing Address - Country:US
Mailing Address - Phone:207-945-4240
Mailing Address - Fax:207-990-3660
Practice Address - Street 1:40 SUMMER ST
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-6446
Practice Address - Country:US
Practice Address - Phone:207-945-4240
Practice Address - Fax:207-990-3660
Is Sole Proprietor?:No
Enumeration Date:2007-09-20
Last Update Date:2011-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEXL3301101YP2500X
MECC3591101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional