Provider Demographics
NPI:1700546421
Name:BAKER, JEREMIAH PETER (LCSW)
Entity type:Individual
Prefix:
First Name:JEREMIAH
Middle Name:PETER
Last Name:BAKER
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 POMEROY AVE STE 201I
Mailing Address - Street 2:
Mailing Address - City:MERIDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06450-8316
Mailing Address - Country:US
Mailing Address - Phone:860-919-6770
Mailing Address - Fax:
Practice Address - Street 1:250 POMEROY AVE STE 201I
Practice Address - Street 2:
Practice Address - City:MERIDEN
Practice Address - State:CT
Practice Address - Zip Code:06450-8316
Practice Address - Country:US
Practice Address - Phone:860-919-6770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-21
Last Update Date:2024-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0118441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical