Provider Demographics
NPI:1952608671
Name:BAKER, WILLIAM G (PSYD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:G
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 1:15 E 11TH ST APT 1L
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-4412
Mailing Address - Country:US
Mailing Address - Phone:212-203-5085
Mailing Address - Fax:
Practice Address - Street 1:15 E 11TH ST APT 1L
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-4412
Practice Address - Country:US
Practice Address - Phone:212-203-5085
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-15
Last Update Date:2011-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018661-1103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist