Provider Demographics
NPI:1013971217
Name:BAKER, MINNA RAE (PHD)
Entity Type:Individual
Prefix:DR
First Name:MINNA
Middle Name:RAE
Last Name:BAKER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:M.
Other - Middle Name:R
Other - Last Name:BAKER, P.C.
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:431 PENN VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:NARBERTH
Mailing Address - State:PA
Mailing Address - Zip Code:19072-1623
Mailing Address - Country:US
Mailing Address - Phone:610-667-4896
Mailing Address - Fax:610-771-0871
Practice Address - Street 1:431 PENN VALLEY RD
Practice Address - Street 2:
Practice Address - City:PENN VALLEY
Practice Address - State:PA
Practice Address - Zip Code:19072-1623
Practice Address - Country:US
Practice Address - Phone:610-667-4896
Practice Address - Fax:610-771-0871
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2008-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS002668103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA099241Medicare PIN
PA14906U53Medicare PIN