Provider Demographics
NPI:1164664934
Name:BAKER, JEAN M (LCSW-R)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:M
Last Name:BAKER
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 FOUNTAIN ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:CLINTON
Mailing Address - State:NY
Mailing Address - Zip Code:13323-1745
Mailing Address - Country:US
Mailing Address - Phone:315-292-4834
Mailing Address - Fax:
Practice Address - Street 1:3 FOUNTAIN ST
Practice Address - Street 2:SUITE 201
Practice Address - City:CLINTON
Practice Address - State:NY
Practice Address - Zip Code:13323-1745
Practice Address - Country:US
Practice Address - Phone:315-292-4834
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-25
Last Update Date:2016-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR058181-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical