Provider Demographics
NPI:1235253501
Name:BAKER, JEFFERY L (PHD)
Entity Type:Individual
Prefix:DR
First Name:JEFFERY
Middle Name:L
Last Name:BAKER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 TOLBERT RD
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:OH
Mailing Address - Zip Code:45011-9642
Mailing Address - Country:US
Mailing Address - Phone:513-478-4917
Mailing Address - Fax:513-452-4158
Practice Address - Street 1:1900 TOLBERT RD
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:OH
Practice Address - Zip Code:45011
Practice Address - Country:US
Practice Address - Phone:513-726-5551
Practice Address - Fax:513-726-5551
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6450103TC0700X
OH923219101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)