Provider Demographics
NPI:1225561582
Name:BAKER, MOLLIE BRYNNE (LCSW)
Entity Type:Individual
Prefix:
First Name:MOLLIE
Middle Name:BRYNNE
Last Name:BAKER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MOLLIE
Other - Middle Name:BRYNNE
Other - Last Name:DUGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:327 WILBUR CEMETERY RD
Mailing Address - Street 2:
Mailing Address - City:WILBUR
Mailing Address - State:OR
Mailing Address - Zip Code:97494-0201
Mailing Address - Country:US
Mailing Address - Phone:267-619-4973
Mailing Address - Fax:
Practice Address - Street 1:1400 BLACKHORSE HILL RD
Practice Address - Street 2:
Practice Address - City:COATESVILLE
Practice Address - State:PA
Practice Address - Zip Code:19320-2040
Practice Address - Country:US
Practice Address - Phone:610-384-7711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-04
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW131964104100000X
ORL127451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker