Provider Demographics
NPI:1417924069
Name:BAKER, CECEILIA MCADAMS (LCSW LMFT)
Entity Type:Individual
Prefix:MS
First Name:CECEILIA
Middle Name:MCADAMS
Last Name:BAKER
Suffix:
Gender:F
Credentials:LCSW LMFT
Other - Prefix:MS
Other - First Name:MARIAN
Other - Middle Name:CECEILIA
Other - Last Name:MCADAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW LMFT
Mailing Address - Street 1:216 E FLAGET ST
Mailing Address - Street 2:
Mailing Address - City:BARDSTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40004-1520
Mailing Address - Country:US
Mailing Address - Phone:502-331-1900
Mailing Address - Fax:502-349-1325
Practice Address - Street 1:106 MANOR AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:BARDSTOWN
Practice Address - State:KY
Practice Address - Zip Code:40004-2270
Practice Address - Country:US
Practice Address - Phone:502-331-9433
Practice Address - Fax:502-349-1325
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-02
Last Update Date:2013-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0820104100000X
KY0387106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
11405612OtherCAQH
4660971OtherAETNA
343580OtherMHN
000000039714OtherANTHEM
KYCSW0122Medicare PIN