Provider Demographics
NPI:1356786826
Name:BAKER, SHERA (LICSW)
Entity type:Individual
Prefix:
First Name:SHERA
Middle Name:
Last Name:BAKER
Suffix:
Gender:
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 CARRS LN
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886-0674
Mailing Address - Country:US
Mailing Address - Phone:401-644-2062
Mailing Address - Fax:401-633-6133
Practice Address - Street 1:400 RESERVOIR AVE STE 2L
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02907-3594
Practice Address - Country:US
Practice Address - Phone:401-649-7523
Practice Address - Fax:401-313-3419
Is Sole Proprietor?:No
Enumeration Date:2013-05-09
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RICSW015301041C0700X
RIISW028211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIGH57134Medicaid