Provider Demographics
NPI:1144764192
Name:BAKER, LAUREN GLICK (PSYD)
Entity Type:Individual
Prefix:DR
First Name:LAUREN
Middle Name:GLICK
Last Name:BAKER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 W 72ND ST
Mailing Address - Street 2:SUITE 5E6
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-3204
Mailing Address - Country:US
Mailing Address - Phone:917-740-8286
Mailing Address - Fax:
Practice Address - Street 1:117 W 72ND ST
Practice Address - Street 2:SUITE 5E6
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-3204
Practice Address - Country:US
Practice Address - Phone:917-740-8286
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-09
Last Update Date:2017-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021941103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist