Provider Demographics
NPI:1457690331
Name:BAKER, ELIZABETH DIANE (LCSW)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:DIANE
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 1:318 FRANCHI WAY
Mailing Address - Street 2:
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78130-5181
Mailing Address - Country:US
Mailing Address - Phone:413-588-6260
Mailing Address - Fax:
Practice Address - Street 1:3006 BEE CAVES RD
Practice Address - Street 2:SUITE D-310
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78746-5588
Practice Address - Country:US
Practice Address - Phone:512-469-0889
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-12
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 104100000X
MA1201631041C0700X
TX640001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker