Provider Demographics
NPI:1114183134
Name:BAKER, MARY ELIZABETH (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:ELIZABETH
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 1:7293 SHADY GROVE RD
Mailing Address - Street 2:
Mailing Address - City:MECHANICSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23111-2129
Mailing Address - Country:US
Mailing Address - Phone:804-398-8401
Mailing Address - Fax:804-980-7743
Practice Address - Street 1:7293 SHADY GROVE RD
Practice Address - Street 2:
Practice Address - City:MECHANICSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23111-2129
Practice Address - Country:US
Practice Address - Phone:804-398-8401
Practice Address - Fax:804-980-7743
Is Sole Proprietor?:No
Enumeration Date:2008-07-29
Last Update Date:2013-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040068641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical