Provider Demographics
NPI:1710062674
Name:BAXTER, MARLA L (MSW)
Entity Type:Individual
Prefix:MS
First Name:MARLA
Middle Name:L
Last Name:BAXTER
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:465 VIA MAXWELL
Mailing Address - Street 2:
Mailing Address - City:NIPOMO
Mailing Address - State:CA
Mailing Address - Zip Code:93444-9698
Mailing Address - Country:US
Mailing Address - Phone:805-929-8393
Mailing Address - Fax:
Practice Address - Street 1:300 N SAN ANTONIO RD
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93110-1316
Practice Address - Country:US
Practice Address - Phone:805-681-5220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW114261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical