Provider Demographics
NPI:1750677506
Name:BAKER, ELIZABETH HEYMAN (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:HEYMAN
Last Name:BAKER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:253 STONEFIELD LN
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:14425-7074
Mailing Address - Country:US
Mailing Address - Phone:585-869-5168
Mailing Address - Fax:
Practice Address - Street 1:2350 E RIDGE RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14622-2721
Practice Address - Country:US
Practice Address - Phone:585-339-1443
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-21
Last Update Date:2011-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0568291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical