Provider Demographics
NPI:1558491092
Name:BAIRD, PHILIP DONALD (MSW LCSW)
Entity Type:Individual
Prefix:MR
First Name:PHILIP
Middle Name:DONALD
Last Name:BAIRD
Suffix:
Gender:M
Credentials:MSW LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 RIVERSIDE DRIVE
Mailing Address - Street 2:#306
Mailing Address - City:CRANFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07016
Mailing Address - Country:US
Mailing Address - Phone:908-709-3791
Mailing Address - Fax:
Practice Address - Street 1:655 WESTFIELD AVE
Practice Address - Street 2:JEWISH FAMILY SERVICE
Practice Address - City:ELIZABETH
Practice Address - State:NJ
Practice Address - Zip Code:07208
Practice Address - Country:US
Practice Address - Phone:908-352-8375
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC04696400104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0036200Medicaid
NJ668580Medicare ID - Type Unspecified