Provider Demographics
NPI:1407496102
Name:BAIRD, THOMAS ROGER (LCSW)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:ROGER
Last Name:BAIRD
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10389 DEVILLO DR
Mailing Address - Street 2:
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90604-1658
Mailing Address - Country:US
Mailing Address - Phone:562-665-7293
Mailing Address - Fax:
Practice Address - Street 1:149 W LAMBERT RD
Practice Address - Street 2:
Practice Address - City:BREA
Practice Address - State:CA
Practice Address - Zip Code:92821-4042
Practice Address - Country:US
Practice Address - Phone:562-665-7293
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-10
Last Update Date:2020-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA847601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical