Provider Demographics
NPI:1407273980
Name:BAIDEN, JACOB F (BS/ED)
Entity Type:Individual
Prefix:MR
First Name:JACOB
Middle Name:F
Last Name:BAIDEN
Suffix:
Gender:M
Credentials:BS/ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47 HAMPTON GATE DR
Mailing Address - Street 2:
Mailing Address - City:SICKLERVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08081-2517
Mailing Address - Country:US
Mailing Address - Phone:856-875-8581
Mailing Address - Fax:
Practice Address - Street 1:47 HAMPTON GATE DR
Practice Address - Street 2:
Practice Address - City:SICKLERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08081-2517
Practice Address - Country:US
Practice Address - Phone:856-875-8581
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-24
Last Update Date:2014-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health