Provider Demographics
NPI:1518195940
Name:BAIRD, LORI SUZANNE (MFT)
Entity Type:Individual
Prefix:MS
First Name:LORI
Middle Name:SUZANNE
Last Name:BAIRD
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3226 WILKINS RD
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-9568
Mailing Address - Country:US
Mailing Address - Phone:607-274-5032
Mailing Address - Fax:607-275-5673
Practice Address - Street 1:3226 WILKINS RD
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-9568
Practice Address - Country:US
Practice Address - Phone:607-274-5032
Practice Address - Fax:607-275-5673
Is Sole Proprietor?:No
Enumeration Date:2009-06-24
Last Update Date:2009-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000587106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist