Provider Demographics
NPI:1083054068
Name:BAKER, SHATAYIA (LCSW)
Entity Type:Individual
Prefix:
First Name:SHATAYIA
Middle Name:
Last Name:BAKER
Suffix:
Gender:F
Credentials:LCSW
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 21
Mailing Address - Street 2:
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95741-0021
Mailing Address - Country:US
Mailing Address - Phone:916-520-9114
Mailing Address - Fax:
Practice Address - Street 1:9719 LINCOLN VILLAGE DR STE 504
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95827-3332
Practice Address - Country:US
Practice Address - Phone:916-365-4044
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-05
Last Update Date:2023-11-27
Deactivation Date:2022-12-28
Deactivation Code:
Reactivation Date:2023-01-25
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA87425OtherBBS