Provider Demographics
NPI:1184342115
Name:BAKO, AMY
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:BAKO
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 1:81 WARWICK TPKE
Mailing Address - Street 2:
Mailing Address - City:HEWITT
Mailing Address - State:NJ
Mailing Address - Zip Code:07421-2816
Mailing Address - Country:US
Mailing Address - Phone:973-506-6645
Mailing Address - Fax:973-506-4533
Practice Address - Street 1:81 WARWICK TPKE
Practice Address - Street 2:
Practice Address - City:HEWITT
Practice Address - State:NJ
Practice Address - Zip Code:07421-2816
Practice Address - Country:US
Practice Address - Phone:973-506-6645
Practice Address - Fax:973-506-4533
Is Sole Proprietor?:No
Enumeration Date:2022-08-16
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00647200101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor