MEDICARE: BONNIE BAKER LCSW

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	SW6815	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1528174083
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BONNIE BAKER LCSW

Provider Business Mailing Address
First Line	:	3301 N COUNTRY CLUB DR
Second Line	:	#801
City	:	AVENTURA
State	:	FL
Zip	:	33180
Country	:	US
Telephone Number	:	305-244-4887
Fax Number	:	305-558-6134

Provider Business Practice Location Address
First Line	:	6175 NW 153 ST
Second Line	:	#404
City	:	MIAMI LAKES
State	:	FL
Zip	:	33014
Country	:	US
Telephone Number	:	305-558-7400
Fax Number	:	305-558-6134

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

Provider Enumeration Date	:	08/21/2006
Last Update Date	:	10/09/2009

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