Provider Demographics
NPI:1922211184
Name:BAKER, CHARLES E (PHD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:E
Last Name:BAKER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 E HAMILTON AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CAMPBELL
Mailing Address - State:CA
Mailing Address - Zip Code:95008-0664
Mailing Address - Country:US
Mailing Address - Phone:408-879-7327
Mailing Address - Fax:408-879-7328
Practice Address - Street 1:900 E HAMILTON AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:CAMPBELL
Practice Address - State:CA
Practice Address - Zip Code:95008-0664
Practice Address - Country:US
Practice Address - Phone:408-879-7327
Practice Address - Fax:408-879-7328
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 18034103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist