Provider Demographics
NPI:1093914913
Name:BAKER, NANCY LYNN (PHD, ABPP)
Entity Type:Individual
Prefix:DR
First Name:NANCY
Middle Name:LYNN
Last Name:BAKER
Suffix:
Gender:F
Credentials:PHD, ABPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1611 BOREL PL
Mailing Address - Street 2:#211
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94402-3500
Mailing Address - Country:US
Mailing Address - Phone:650-712-9767
Mailing Address - Fax:
Practice Address - Street 1:1611 BOREL PL
Practice Address - Street 2:#211
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94402-3500
Practice Address - Country:US
Practice Address - Phone:650-712-9767
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-11
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY11673103TA0700X, 103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
No103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & Aging