Provider Demographics
NPI:1801119623
Name:BAKER, DAVID (PSYD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:
Last Name:BAKER
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2800 WINSLOW AVE
Mailing Address - Street 2:SUITE 5200
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45206-1144
Mailing Address - Country:US
Mailing Address - Phone:513-636-0755
Mailing Address - Fax:513-636-0755
Practice Address - Street 1:2800 WINSLOW AVE
Practice Address - Street 2:SUITE 5200
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45206-1144
Practice Address - Country:US
Practice Address - Phone:513-636-0755
Practice Address - Fax:513-636-0755
Is Sole Proprietor?:No
Enumeration Date:2010-03-08
Last Update Date:2011-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6825103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1801119623Medicaid