Provider Demographics
NPI:1699027318
Name:MOMOT-BAKER, MARGARET (PHD)
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:
Last Name:MOMOT-BAKER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:MARGARET
Other - Middle Name:
Other - Last Name:MOMOT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:303 MERRICK RD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:LYNBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11563-2501
Mailing Address - Country:US
Mailing Address - Phone:800-725-6280
Mailing Address - Fax:800-725-6380
Practice Address - Street 1:1070 LUTHER RD
Practice Address - Street 2:
Practice Address - City:EAST GREENBUSH
Practice Address - State:NY
Practice Address - Zip Code:12061-4020
Practice Address - Country:US
Practice Address - Phone:518-479-4662
Practice Address - Fax:518-477-4465
Is Sole Proprietor?:No
Enumeration Date:2012-10-04
Last Update Date:2012-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019456103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical