Provider Demographics
NPI:1295002178
Name:BAIRD, ALICIA R (PHD)
Entity Type:Individual
Prefix:DR
First Name:ALICIA
Middle Name:R
Last Name:BAIRD
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:ALICIA
Other - Middle Name:R
Other - Last Name:BAIRD-FASSARDI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:701 GARDEN VIEW CT STE 18
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-2464
Mailing Address - Country:US
Mailing Address - Phone:760-845-2658
Mailing Address - Fax:
Practice Address - Street 1:701 GARDEN VIEW CT STE 18
Practice Address - Street 2:
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-2464
Practice Address - Country:US
Practice Address - Phone:760-845-2658
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-21
Last Update Date:2016-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY22576103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical