Provider Demographics
NPI:1881214559
Name:BAKER, MELANIE
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:
Last Name:BAKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7301 INDIAN SCHOOL RD NE STE A
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-4504
Mailing Address - Country:US
Mailing Address - Phone:505-362-2326
Mailing Address - Fax:052-660-5045
Practice Address - Street 1:7301 INDIAN SCHOOL RD NE STE A
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-4504
Practice Address - Country:US
Practice Address - Phone:505-266-0441
Practice Address - Fax:801-459-1200
Is Sole Proprietor?:No
Enumeration Date:2020-04-22
Last Update Date:2020-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
M11262104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker