Provider Demographics
NPI:1568506137
Name:BAKER, JOHN EDGAR (PHD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:EDGAR
Last Name:BAKER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:68 LEONARD ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:BELMONT
Mailing Address - State:MA
Mailing Address - Zip Code:02478-2522
Mailing Address - Country:US
Mailing Address - Phone:617-484-4447
Mailing Address - Fax:781-641-0457
Practice Address - Street 1:68 LEONARD ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:BELMONT
Practice Address - State:MA
Practice Address - Zip Code:02478-2522
Practice Address - Country:US
Practice Address - Phone:617-484-4447
Practice Address - Fax:781-641-0457
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-16
Last Update Date:2007-08-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA3118103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW03227OtherBLUE CROSS BLUE SHIELD