Provider Demographics
NPI:1336447028
Name:BAKER, DAVID A (MSW)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:A
Last Name:BAKER
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29600 NORTHWESTERN HWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034-1016
Mailing Address - Country:US
Mailing Address - Phone:248-353-0050
Mailing Address - Fax:
Practice Address - Street 1:29600 NORTHWESTERN HWY
Practice Address - Street 2:SUITE 100
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-1016
Practice Address - Country:US
Practice Address - Phone:248-353-0050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-04
Last Update Date:2011-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010113131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical