Provider Demographics
NPI:1003783523
Name:BAKER, LEA EVANGELINE
Entity type:Individual
Prefix:
First Name:LEA
Middle Name:EVANGELINE
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 1:1140 S ORLANDO AVE APT K5
Mailing Address - Street 2:
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-6434
Mailing Address - Country:US
Mailing Address - Phone:470-572-1434
Mailing Address - Fax:
Practice Address - Street 1:15425 SOUTHERN MARTIN ST
Practice Address - Street 2:
Practice Address - City:WINTER GARDEN
Practice Address - State:FL
Practice Address - Zip Code:34787-4898
Practice Address - Country:US
Practice Address - Phone:470-572-1434
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-20
Last Update Date:2025-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty