Provider Demographics
NPI:1205459724
Name:BAKER, SEAN ALEXANDER
Entity type:Individual
Prefix:
First Name:SEAN
Middle Name:ALEXANDER
Last Name:BAKER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:806 NEW ORCHARD PL
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-2241
Mailing Address - Country:US
Mailing Address - Phone:301-281-1062
Mailing Address - Fax:
Practice Address - Street 1:10632 LITTLE PATUXENT PKWY STE 327
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-6283
Practice Address - Country:US
Practice Address - Phone:443-864-5647
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-19
Last Update Date:2020-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC10120101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDLC10120OtherLCPC