Provider Demographics
NPI:1093210585
Name:BAKER, PATRICE SAMANTHA
Entity Type:Individual
Prefix:
First Name:PATRICE
Middle Name:SAMANTHA
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 1:1803 ALLENDALE CT
Mailing Address - Street 2:
Mailing Address - City:LANDOVER
Mailing Address - State:MD
Mailing Address - Zip Code:20785-4227
Mailing Address - Country:US
Mailing Address - Phone:240-839-2325
Mailing Address - Fax:
Practice Address - Street 1:3814 12TH ST NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20017-2630
Practice Address - Country:US
Practice Address - Phone:202-569-1877
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-27
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician