Provider Demographics
NPI:1811191067
Name:CARLY BAKER
Entity Type:Organization
Organization Name:CARLY BAKER
Other - Org Name:FORBES ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CARLY
Authorized Official - Middle Name:F
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:508-641-2628
Mailing Address - Street 1:65 HILL ST
Mailing Address - Street 2:
Mailing Address - City:BARRE
Mailing Address - State:VT
Mailing Address - Zip Code:05641-4204
Mailing Address - Country:US
Mailing Address - Phone:508-641-2628
Mailing Address - Fax:
Practice Address - Street 1:50 ADAMS ST
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02460-1461
Practice Address - Country:US
Practice Address - Phone:508-641-2628
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-12
Last Update Date:2007-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP23224Medicare PIN