Provider Demographics
NPI:1407628720
Name:BAKER, MERLAND ANTHONY JR
Entity Type:Individual
Prefix:MR
First Name:MERLAND
Middle Name:ANTHONY
Last Name:BAKER
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3452 LIVE OAK HOLLOW DR
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32065-2525
Mailing Address - Country:US
Mailing Address - Phone:904-472-3208
Mailing Address - Fax:
Practice Address - Street 1:13926 FLAME WOOD CT APT 202
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-4799
Practice Address - Country:US
Practice Address - Phone:904-472-3208
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-30
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLISW194401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical