Provider Demographics
NPI:1134299431
Name:BAKER, CATHERINE (LICSW)
Entity Type:Individual
Prefix:MRS
First Name:CATHERINE
Middle Name:
Last Name:BAKER
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 FAIR OAKS DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02421-6940
Mailing Address - Country:US
Mailing Address - Phone:781-938-5954
Mailing Address - Fax:781-938-7152
Practice Address - Street 1:8 CEDAR ST
Practice Address - Street 2:SUITE 58
Practice Address - City:WOBURN
Practice Address - State:MA
Practice Address - Zip Code:01801-6361
Practice Address - Country:US
Practice Address - Phone:781-938-5954
Practice Address - Fax:781-838-7152
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2013-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALADC I 1293101YA0400X
MALICSW 1013301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MABAP22584Medicare ID - Type Unspecified