Provider Demographics
NPI:1457402372
Name:BAKER, CATHY ELLEN (LICSW)
Entity Type:Individual
Prefix:MS
First Name:CATHY
Middle Name:ELLEN
Last Name:BAKER
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:MS
Other - First Name:KATE
Other - Middle Name:E
Other - Last Name:BAKER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LICSW
Mailing Address - Street 1:66 KNEELAND ST
Mailing Address - Street 2:
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02905-3308
Mailing Address - Country:US
Mailing Address - Phone:401-374-1683
Mailing Address - Fax:
Practice Address - Street 1:55 CUMMINGS WAY
Practice Address - Street 2:
Practice Address - City:WOONSOCKET
Practice Address - State:RI
Practice Address - Zip Code:02895-3247
Practice Address - Country:US
Practice Address - Phone:401-374-1683
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2010-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIISW008041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR21492-8OtherBLUE CROSS
PR407825OtherBLUE CHIP
RI1036840OtherNHPRI