Provider Demographics
NPI:1770541237
Name:BAKER, MILDRED F (LCSW)
Entity type:Individual
Prefix:
First Name:MILDRED
Middle Name:F
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 1:328 BASSLER ST
Mailing Address - Street 2:
Mailing Address - City:MARTINSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:16662-1417
Mailing Address - Country:US
Mailing Address - Phone:814-934-0303
Mailing Address - Fax:814-793-0916
Practice Address - Street 1:328 BASSLER ST
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:PA
Practice Address - Zip Code:16662-1417
Practice Address - Country:US
Practice Address - Phone:814-934-0303
Practice Address - Fax:814-793-0916
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-03
Last Update Date:2016-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW016550101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PASW012321LOtherSTATE SOCIAL WORK LICENSE
PA0077163600005Medicaid
PACW016550OtherLCSW