Provider Demographics
NPI:1700012580
Name:BAKER, THOM STEPHEN (LICSW)
Entity Type:Individual
Prefix:MR
First Name:THOM
Middle Name:STEPHEN
Last Name:BAKER
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 SPRINGS RD
Mailing Address - Street 2:BUILDING 16
Mailing Address - City:BEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01730-1114
Mailing Address - Country:US
Mailing Address - Phone:781-687-3421
Mailing Address - Fax:781-687-3300
Practice Address - Street 1:200 SPRINGS RD
Practice Address - Street 2:BUILDING 16
Practice Address - City:BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:01730-1114
Practice Address - Country:US
Practice Address - Phone:781-687-3421
Practice Address - Fax:781-687-3300
Is Sole Proprietor?:No
Enumeration Date:2009-06-07
Last Update Date:2012-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1111301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical