Provider Demographics
NPI:1275913618
Name:BAKER, CHRISTINE YOUNG
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:YOUNG
Last Name:BAKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:YOUNG
Other - Last Name:BAKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:20871 JOHNSON ST STE 105
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33029-1918
Mailing Address - Country:US
Mailing Address - Phone:954-593-4097
Mailing Address - Fax:954-404-6198
Practice Address - Street 1:20871 JOHNSON ST STE 105
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33029-1918
Practice Address - Country:US
Practice Address - Phone:954-843-0273
Practice Address - Fax:954-404-6198
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-01
Last Update Date:2023-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 13390101YM0800X
171M00000X, 251B00000X
FLMH13390103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL101057900Medicaid
FL105672500Medicaid