Provider Demographics
NPI:1467636993
Name:BAER, LEAH (PSYD)
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:
Last Name:BAER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:491 STEVENS AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04103-2636
Mailing Address - Country:US
Mailing Address - Phone:207-828-4026
Mailing Address - Fax:207-773-4472
Practice Address - Street 1:491 STEVENS AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04103-2636
Practice Address - Country:US
Practice Address - Phone:207-828-4026
Practice Address - Fax:207-773-4472
Is Sole Proprietor?:No
Enumeration Date:2007-12-19
Last Update Date:2007-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPS1223103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical