Provider Demographics
NPI:1801860408
Name:BAKER, JEAN E (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:JEAN
Middle Name:E
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 1:1313 LAUREL ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SAN CARLOS
Mailing Address - State:CA
Mailing Address - Zip Code:94070-5044
Mailing Address - Country:US
Mailing Address - Phone:650-593-6870
Mailing Address - Fax:650-631-9982
Practice Address - Street 1:1313 LAUREL ST
Practice Address - Street 2:SUITE 200
Practice Address - City:SAN CARLOS
Practice Address - State:CA
Practice Address - Zip Code:94070-5044
Practice Address - Country:US
Practice Address - Phone:650-593-6870
Practice Address - Fax:650-631-9982
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 89191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ16669ZMedicare ID - Type UnspecifiedPROVIDER IDENTIFICATION N