Provider Demographics
NPI:1073778569
Name:BAKER, ELISA MARIA (LMSW)
Entity Type:Individual
Prefix:
First Name:ELISA
Middle Name:MARIA
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 1:400 AIRPORT RD
Mailing Address - Street 2:
Mailing Address - City:TERRELL
Mailing Address - State:TX
Mailing Address - Zip Code:75160-4302
Mailing Address - Country:US
Mailing Address - Phone:972-524-4159
Mailing Address - Fax:
Practice Address - Street 1:400 AIRPORT RD
Practice Address - Street 2:
Practice Address - City:TERRELL
Practice Address - State:TX
Practice Address - Zip Code:75160-4302
Practice Address - Country:US
Practice Address - Phone:972-524-4159
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-23
Last Update Date:2008-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX51470104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker