Provider Demographics
NPI:1790872257
Name:BAKER, MARY K (LCSW)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:K
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:PO BOX 924
Mailing Address - Street 2:
Mailing Address - City:HERKIMER
Mailing Address - State:NY
Mailing Address - Zip Code:13350-0924
Mailing Address - Country:US
Mailing Address - Phone:315-866-8283
Mailing Address - Fax:315-866-7488
Practice Address - Street 1:426 NORTH MAIN ST
Practice Address - Street 2:
Practice Address - City:HERKIMER
Practice Address - State:NY
Practice Address - Zip Code:13350-0924
Practice Address - Country:US
Practice Address - Phone:315-866-8283
Practice Address - Fax:315-866-7488
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY04792011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
615505OtherMVP INS
DD3050Medicare ID - Type Unspecified
615505OtherMVP INS