Provider Demographics
NPI:1518281997
Name:BAKER, RONALD BRUCE (MCW,LCSW)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:BRUCE
Last Name:BAKER
Suffix:
Gender:M
Credentials:MCW,LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2645 SHAKESOEARE AVE.
Mailing Address - Street 2:
Mailing Address - City:OVERLAND
Mailing Address - State:MO
Mailing Address - Zip Code:63114
Mailing Address - Country:US
Mailing Address - Phone:314-239-3360
Mailing Address - Fax:
Practice Address - Street 1:101 N CORONADO DR
Practice Address - Street 2:A
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85635-6358
Practice Address - Country:US
Practice Address - Phone:520-792-1450
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-15
Last Update Date:2010-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20100013251041C0700X
DEQ1-00009891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical