Provider Demographics
NPI:1720707383
Name:BAKER, MAXWELL ANDREW (CT)
Entity Type:Individual
Prefix:
First Name:MAXWELL
Middle Name:ANDREW
Last Name:BAKER
Suffix:
Gender:M
Credentials:CT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49 JOHNSON RD
Mailing Address - Street 2:
Mailing Address - City:THE PLAINS
Mailing Address - State:OH
Mailing Address - Zip Code:45780-1146
Mailing Address - Country:US
Mailing Address - Phone:740-764-4529
Mailing Address - Fax:
Practice Address - Street 1:49 JOHNSON RD
Practice Address - Street 2:
Practice Address - City:THE PLAINS
Practice Address - State:OH
Practice Address - Zip Code:45780-1146
Practice Address - Country:US
Practice Address - Phone:740-764-4529
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-25
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.2405517-TRNE101Y00000X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No171M00000XOther Service ProvidersCase Manager/Care Coordinator