Provider Demographics
NPI:1790022127
Name:BAKER, RUSSELL (CASAC)
Entity Type:Individual
Prefix:MR
First Name:RUSSELL
Middle Name:
Last Name:BAKER
Suffix:
Gender:M
Credentials:CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 N HAMILTON ST
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12601-2541
Mailing Address - Country:US
Mailing Address - Phone:845-483-5512
Mailing Address - Fax:845-483-5054
Practice Address - Street 1:29 N HAMILTON ST
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601-2541
Practice Address - Country:US
Practice Address - Phone:845-483-5512
Practice Address - Fax:845-483-5054
Is Sole Proprietor?:No
Enumeration Date:2013-01-04
Last Update Date:2013-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)