Provider Demographics
NPI:1790892362
Name:BAKER, MARCIA MAY (MA)
Entity Type:Individual
Prefix:MRS
First Name:MARCIA
Middle Name:MAY
Last Name:BAKER
Suffix:
Gender:F
Credentials:MA
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 223
Mailing Address - Street 2:150 BERKSHIRE RD.
Mailing Address - City:RANGELEY
Mailing Address - State:ME
Mailing Address - Zip Code:04970-0223
Mailing Address - Country:US
Mailing Address - Phone:207-864-3351
Mailing Address - Fax:207-864-3351
Practice Address - Street 1:150 BERKSHIRE RD.
Practice Address - Street 2:
Practice Address - City:RANGELEY
Practice Address - State:ME
Practice Address - Zip Code:04970-0223
Practice Address - Country:US
Practice Address - Phone:207-864-3351
Practice Address - Fax:207-864-3351
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELCPC #591 LMFT #592101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME53983OtherMAGELLAN HEALTH SERVICES
ME2668197OtherAETNA PIN
ME4315535699OtherMAINECARE THROUGH PROTEA
ME358286OtherKTRICARE
ME003806OtherANTHEM BLUE CROSS