Provider Demographics
NPI:1952634404
Name:BAKER, LEWIE EVAN (MSW)
Entity Type:Individual
Prefix:MR
First Name:LEWIE
Middle Name:EVAN
Last Name:BAKER
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:919 RENCHER ST
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:NM
Mailing Address - Zip Code:88101-5858
Mailing Address - Country:US
Mailing Address - Phone:575-769-2142
Mailing Address - Fax:575-769-2162
Practice Address - Street 1:919 RENCHER ST
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:NM
Practice Address - Zip Code:88101-5858
Practice Address - Country:US
Practice Address - Phone:575-769-2142
Practice Address - Fax:575-769-2162
Is Sole Proprietor?:No
Enumeration Date:2009-09-16
Last Update Date:2009-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical