Provider Demographics
NPI:1558808253
Name:BAKER, AMANDA RACHEL (LMFT)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:RACHEL
Last Name:BAKER
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15195 ASPEN LN
Mailing Address - Street 2:APT. B
Mailing Address - City:WATERTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13601-6618
Mailing Address - Country:US
Mailing Address - Phone:315-420-3897
Mailing Address - Fax:
Practice Address - Street 1:15195 ASPEN LN
Practice Address - Street 2:APT. B
Practice Address - City:WATERTOWN
Practice Address - State:NY
Practice Address - Zip Code:13601-6618
Practice Address - Country:US
Practice Address - Phone:315-420-3897
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-20
Last Update Date:2017-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001161-1106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist