Provider Demographics
NPI:1861653917
Name:BAKER, SUSAN M (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:M
Last Name:BAKER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:SUSAN
Other - Middle Name:MARIE
Other - Last Name:SELLERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LSW
Mailing Address - Street 1:674 ROYAL SAINT GEORGE DR
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46143-1939
Mailing Address - Country:US
Mailing Address - Phone:812-372-3473
Mailing Address - Fax:
Practice Address - Street 1:720 EXECUTIVE PARK DR STE 3000D
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46143-3204
Practice Address - Country:US
Practice Address - Phone:812-372-3473
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-20
Last Update Date:2020-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34005093A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical