MEDICARE: MS. KERI BAKER

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	104100000X	Social Worker	074253-1	NY
2	1041C0700X	Clinical Social Worker	ISW15274	FL

General Provider Information

NPI Number	:	1063658201
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KERI BAKER

Provider Business Mailing Address
First Line	:	15616 DEERGLEN DR
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33624-1712
Country	:	US
Telephone Number	:	203-218-5053
Fax Number	:

Provider Business Practice Location Address
First Line	:	15616 DEERGLEN DR
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33624-1712
Country	:	US
Telephone Number	:	203-218-5053
Fax Number	:

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

Provider Enumeration Date	:	12/17/2008
Last Update Date	:	06/16/2022

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Directions to “ MS. KERI BAKER ” Practice Location

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