Provider Demographics
NPI:1396583233
Name:BAKE, LEO JAMES
Entity type:Individual
Prefix:
First Name:LEO
Middle Name:JAMES
Last Name:BAKE
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5850 ELLSWORTH AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15232-1775
Mailing Address - Country:US
Mailing Address - Phone:724-777-1433
Mailing Address - Fax:
Practice Address - Street 1:5850 ELLSWORTH AVE STE 200
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15232-1775
Practice Address - Country:US
Practice Address - Phone:724-777-1433
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-16
Last Update Date:2024-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker