Provider Demographics
NPI:1396943262
Name:BAKER, MARCIA KNAPP (LCSW)
Entity type:Individual
Prefix:MS
First Name:MARCIA
Middle Name:KNAPP
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 1:412 CYPRESS GARDENS BLVD
Mailing Address - Street 2:SUITE # 217
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33880-4453
Mailing Address - Country:US
Mailing Address - Phone:863-259-0987
Mailing Address - Fax:863-293-9567
Practice Address - Street 1:412 CYPRESS GARDENS BLVD
Practice Address - Street 2:SUITE # 217
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33880-4453
Practice Address - Country:US
Practice Address - Phone:863-259-0987
Practice Address - Fax:863-293-9567
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW004577E104100000X
FLSW83021041C0700X
NJ44SC049161001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered104100000XBehavioral Health & Social Service ProvidersSocial Worker
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical