Provider Demographics
NPI:1508290305
Name:BAKER, KEITH (LCSW, CASAC)
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:
Last Name:BAKER
Suffix:
Gender:M
Credentials:LCSW, CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 WEST 26TH STREET
Mailing Address - Street 2:4TH FLOOR, SUITE 410
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-6901
Mailing Address - Country:US
Mailing Address - Phone:646-438-9434
Mailing Address - Fax:
Practice Address - Street 1:25 WEST 26TH STREET
Practice Address - Street 2:4TH FLOOR, SUITE 410
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-6901
Practice Address - Country:US
Practice Address - Phone:646-438-9434
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-28
Last Update Date:2018-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY730796761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical