Provider Demographics
NPI:1942237342
Name:BAKER, CARENDA DIANE (LSW)
Entity Type:Individual
Prefix:MS
First Name:CARENDA
Middle Name:DIANE
Last Name:BAKER
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4768 BRIAN RD
Mailing Address - Street 2:
Mailing Address - City:MECHANICSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17050-3087
Mailing Address - Country:US
Mailing Address - Phone:717-795-0330
Mailing Address - Fax:717-795-0407
Practice Address - Street 1:960 CENTURY DR
Practice Address - Street 2:
Practice Address - City:MECHANICSBURG
Practice Address - State:PA
Practice Address - Zip Code:17055-4374
Practice Address - Country:US
Practice Address - Phone:717-795-0330
Practice Address - Fax:717-795-0407
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW-010009-L104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA50045994OtherCAPITAL BLUE CROSS