Provider Demographics
NPI:1558836601
Name:BAKER, CHRISTY LYNN (LSW)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTY
Middle Name:LYNN
Last Name:BAKER
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:MISS
Other - First Name:CHRISTY
Other - Middle Name:LYNN
Other - Last Name:KUYKENDALL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:425 EAST MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:PA
Mailing Address - Zip Code:17724-1633
Mailing Address - Country:US
Mailing Address - Phone:570-673-8662
Mailing Address - Fax:570-673-4904
Practice Address - Street 1:425 EAST MAIN STREET
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:PA
Practice Address - Zip Code:17724-1633
Practice Address - Country:US
Practice Address - Phone:570-673-8662
Practice Address - Fax:570-673-4904
Is Sole Proprietor?:No
Enumeration Date:2018-10-04
Last Update Date:2018-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW124293104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker