Provider Demographics
NPI:1902185770
Name:BAKER, BAHEERAH MEMPHIS
Entity Type:Individual
Prefix:
First Name:BAHEERAH
Middle Name:MEMPHIS
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 1:30 N 18TH ST
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:EAST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07017-5102
Mailing Address - Country:US
Mailing Address - Phone:973-592-9230
Mailing Address - Fax:
Practice Address - Street 1:30 N 18TH ST
Practice Address - Street 2:1ST FLOOR
Practice Address - City:EAST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07017-5102
Practice Address - Country:US
Practice Address - Phone:973-592-9230
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-11
Last Update Date:2011-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency