Provider Demographics
NPI:1275680548
Name:BAKER, CAROL LEE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:CAROL
Middle Name:LEE
Last Name:BAKER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6937 RIVERGATE AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33637-0908
Mailing Address - Country:US
Mailing Address - Phone:813-631-0580
Mailing Address - Fax:
Practice Address - Street 1:3500 E FLETCHER AVE
Practice Address - Street 2:129
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-4708
Practice Address - Country:US
Practice Address - Phone:813-767-6357
Practice Address - Fax:813-978-0475
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2008-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW7981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical