Provider Demographics
NPI:1073902821
Name:BAKER, BRENDAN (MSW, LCSW, LICSW)
Entity Type:Individual
Prefix:
First Name:BRENDAN
Middle Name:
Last Name:BAKER
Suffix:
Gender:M
Credentials:MSW, LCSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9600 VETERANS DR
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98493-0001
Mailing Address - Country:US
Mailing Address - Phone:314-223-1900
Mailing Address - Fax:
Practice Address - Street 1:9600 VETERANS DR
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98493-0001
Practice Address - Country:US
Practice Address - Phone:314-223-1900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-16
Last Update Date:2015-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW604616311041C0700X
MO19991409251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical