Provider Demographics
NPI:1568239184
Name:BAKER, DEVON SHANE
Entity Type:Individual
Prefix:
First Name:DEVON
Middle Name:SHANE
Last Name:BAKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3130 ALPINE RD STE 288 PMB 135
Mailing Address - Street 2:
Mailing Address - City:PORTOLA VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94028-7541
Mailing Address - Country:US
Mailing Address - Phone:650-549-5009
Mailing Address - Fax:
Practice Address - Street 1:327 N SAN MATEO DR STE 9
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94401-2585
Practice Address - Country:US
Practice Address - Phone:650-549-5009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-04
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health