Provider Demographics
NPI:1265772164
Name:BAKER, JESSICA (PHD)
Entity type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:
Last Name:BAKER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 BRIDGEPORT DR
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-8855
Mailing Address - Country:US
Mailing Address - Phone:804-484-9935
Mailing Address - Fax:
Practice Address - Street 1:101 MANNING DRIVE CB 7160
Practice Address - Street 2:UNIVERSITY OF NORTH CAROLINA DEPARTMENT OF PSYCHIATRY
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27713
Practice Address - Country:US
Practice Address - Phone:919-966-1217
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-01
Last Update Date:2013-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4415103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical