Provider Demographics
NPI:1164690889
Name:BAIRD, MARY W (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:W
Last Name:BAIRD
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:MARY
Other - Middle Name:WANDERER
Other - Last Name:BAIRD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:4450 CALIFORNIA AVE
Mailing Address - Street 2:SUITE K-275
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93309-1152
Mailing Address - Country:US
Mailing Address - Phone:661-321-9640
Mailing Address - Fax:
Practice Address - Street 1:NKSP 2737 W. CECIL AVE
Practice Address - Street 2:
Practice Address - City:DELANO
Practice Address - State:CA
Practice Address - Zip Code:93215
Practice Address - Country:US
Practice Address - Phone:661-721-2345
Practice Address - Fax:661-721-6262
Is Sole Proprietor?:No
Enumeration Date:2008-02-15
Last Update Date:2008-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY16763103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical