Provider Demographics
NPI:1013464205
Name:BAKER, PHILIP MASAO (LMFT)
Entity type:Individual
Prefix:MR
First Name:PHILIP
Middle Name:MASAO
Last Name:BAKER
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1320 WILLOW PASS RD STE 600
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94520-5292
Mailing Address - Country:US
Mailing Address - Phone:925-297-5273
Mailing Address - Fax:
Practice Address - Street 1:1320 WILLOW PASS RD STE 600
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94520-5292
Practice Address - Country:US
Practice Address - Phone:925-297-5273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-06
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103451106H00000X
CA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program