Provider Demographics
NPI:1164938783
Name:BAIRD, AMANDA (PHD)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:
Last Name:BAIRD
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 EAGLESHEAD RD
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-9659
Mailing Address - Country:US
Mailing Address - Phone:607-222-2250
Mailing Address - Fax:
Practice Address - Street 1:222 S ALBANY ST
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-5471
Practice Address - Country:US
Practice Address - Phone:607-222-2250
Practice Address - Fax:607-233-4479
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-19
Last Update Date:2021-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022209103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical