Provider Demographics
NPI:1639472129
Name:BAKER, RACHAEL (MS)
Entity Type:Individual
Prefix:
First Name:RACHAEL
Middle Name:
Last Name:BAKER
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1025 S SEMORAN BLVD
Mailing Address - Street 2:SUITE 1093
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-5523
Mailing Address - Country:US
Mailing Address - Phone:407-920-9289
Mailing Address - Fax:
Practice Address - Street 1:1025 S SEMORAN BLVD
Practice Address - Street 2:SUITE 1093
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-5523
Practice Address - Country:US
Practice Address - Phone:407-920-9289
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-06
Last Update Date:2010-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLIMH7962OtherREGISTERED MENTAL HEALTH INTERN IMH 7962