Provider Demographics
NPI:1790198364
Name:BAKER, AMANDA (MSW)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:BAKER
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 1:246 W MAIN ST
Mailing Address - Street 2:MAILBOX 16
Mailing Address - City:MALONE
Mailing Address - State:NY
Mailing Address - Zip Code:12953-1747
Mailing Address - Country:US
Mailing Address - Phone:518-321-5811
Mailing Address - Fax:
Practice Address - Street 1:209 PARK ST
Practice Address - Street 2:
Practice Address - City:MALONE
Practice Address - State:NY
Practice Address - Zip Code:12953-1228
Practice Address - Country:US
Practice Address - Phone:518-483-3261
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-11
Last Update Date:2014-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker