Provider Demographics
NPI:1689726861
Name:BAKER, KATHLEEN MARIE (MED, CAGS, LMHC)
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:MARIE
Last Name:BAKER
Suffix:
Gender:F
Credentials:MED, CAGS, LMHC
Other - Prefix:MRS
Other - First Name:KATE
Other - Middle Name:MARIE
Other - Last Name:BAKER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MED, CAGS, LMHC
Mailing Address - Street 1:2444 E MAIN RD
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:RI
Mailing Address - Zip Code:02871-4025
Mailing Address - Country:US
Mailing Address - Phone:401-683-7460
Mailing Address - Fax:401-683-6212
Practice Address - Street 1:2444 E MAIN RD
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:RI
Practice Address - Zip Code:02871-4025
Practice Address - Country:US
Practice Address - Phone:401-683-7460
Practice Address - Fax:401-683-6212
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2014-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health