Provider Demographics
NPI:1043458003
Name:BAKER, ELLEN MARIE (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:ELLEN
Middle Name:MARIE
Last Name:BAKER
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1830 E ROOSEVELT ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85006-3641
Mailing Address - Country:US
Mailing Address - Phone:602-256-5403
Mailing Address - Fax:602-256-5301
Practice Address - Street 1:1830 E ROOSEVELT ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85006-3641
Practice Address - Country:US
Practice Address - Phone:602-256-5403
Practice Address - Fax:602-256-5301
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-29
Last Update Date:2009-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ12404104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker