Provider Demographics
NPI:1619118163
Name:BAKER, CYNTHIA CARRIE (LMFT)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:CARRIE
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 1:227 RAILROAD AVE
Mailing Address - Street 2:
Mailing Address - City:BEN LOMOND
Mailing Address - State:CA
Mailing Address - Zip Code:95005-9585
Mailing Address - Country:US
Mailing Address - Phone:831-334-7665
Mailing Address - Fax:
Practice Address - Street 1:227 RAILROAD AVE
Practice Address - Street 2:
Practice Address - City:BEN LOMOND
Practice Address - State:CA
Practice Address - Zip Code:95005-9585
Practice Address - Country:US
Practice Address - Phone:831-334-7665
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-12
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LMFT85465106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAIMF 57914OtherIMF