Provider Demographics
NPI:1326562356
Name:BAKER, CLARK ALEXANDER (PSYD)
Entity Type:Individual
Prefix:DR
First Name:CLARK
Middle Name:ALEXANDER
Last Name:BAKER
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:DR
Other - First Name:ALEX
Other - Middle Name:CLARK
Other - Last Name:BAKER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD
Mailing Address - Street 1:24 JAPONICA ST
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:MA
Mailing Address - Zip Code:01970-2360
Mailing Address - Country:US
Mailing Address - Phone:760-846-6670
Mailing Address - Fax:
Practice Address - Street 1:10 FEDERAL ST
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:MA
Practice Address - Zip Code:01970-3860
Practice Address - Country:US
Practice Address - Phone:617-758-8485
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-01
Last Update Date:2022-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health