Provider Demographics
NPI:1750666830
Name:TYRRELL-BAKER, CHRISTINE L (PSYSHOLOGIST)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:L
Last Name:TYRRELL-BAKER
Suffix:
Gender:F
Credentials:PSYSHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:220 HERALD PLACE
Mailing Address - Street 2:4TH FLOOR
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13202-5002
Mailing Address - Country:US
Mailing Address - Phone:315-472-7363
Mailing Address - Fax:315-701-2368
Practice Address - Street 1:220 HERALD PLACE
Practice Address - Street 2:4TH FLOOR
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13202-5002
Practice Address - Country:US
Practice Address - Phone:315-472-7363
Practice Address - Fax:315-701-2368
Is Sole Proprietor?:No
Enumeration Date:2011-10-20
Last Update Date:2011-10-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY014483103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1235184235OtherGRP NPI
BA1047OtherGRP MEDICARE
NY02994838OtherGRP MEDICAID