Provider Demographics
NPI:1073195392
Name:BAKER, GLENDORA Y
Entity Type:Individual
Prefix:
First Name:GLENDORA
Middle Name:Y
Last Name:BAKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5001 SW 20TH ST APT 1301
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34474-8543
Mailing Address - Country:US
Mailing Address - Phone:352-207-5758
Mailing Address - Fax:
Practice Address - Street 1:1554 N MEADOWCREST BLVD
Practice Address - Street 2:
Practice Address - City:CRYSTAL RIVER
Practice Address - State:FL
Practice Address - Zip Code:34429-5756
Practice Address - Country:US
Practice Address - Phone:352-228-4470
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-26
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor