MEDICARE: DR. JUSTIN C BAKER PHD, ABPP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	0810005233	VA

General Provider Information

NPI Number	:	1003137688
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JUSTIN C BAKER PHD, ABPP

Provider Business Mailing Address
First Line	:	3650 OLENTANGY RIVER RD STE 310
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43214-3654
Country	:	US
Telephone Number	:	614-257-2069
Fax Number	:

Provider Business Practice Location Address
First Line	:	3650 OLENTANGY RIVER RD STE 310
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43214-3654
Country	:	US
Telephone Number	:	614-257-2069
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/17/2010
Last Update Date	:	01/04/2023

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