Provider Demographics
NPI:1881629038
Name:BAKER, THOMAS P (LCSW)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:P
Last Name:BAKER
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 N LYNNHAVEN RD
Mailing Address - Street 2:STE 103
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-7523
Mailing Address - Country:US
Mailing Address - Phone:757-486-6955
Mailing Address - Fax:757-486-3258
Practice Address - Street 1:101 N LYNNHAVEN RD
Practice Address - Street 2:STE 103
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-7523
Practice Address - Country:US
Practice Address - Phone:757-437-0008
Practice Address - Fax:757-437-0019
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2016-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040033631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA8901091Medicaid
VA8901091Medicaid