Provider Demographics
NPI:1275657751
Name:BAKER, ERIC WHITE SR (MSSW)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:WHITE
Last Name:BAKER
Suffix:SR
Gender:M
Credentials:MSSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3701 TAYLORSVILLE RD STE 2
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40220-1351
Mailing Address - Country:US
Mailing Address - Phone:502-459-9635
Mailing Address - Fax:
Practice Address - Street 1:3701 TAYLORSVILLE RD STE 2
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40220-1351
Practice Address - Country:US
Practice Address - Phone:502-459-9635
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY 3211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical