MEDICARE: RAENEQUA 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	101YM0800X	Mental Health Counselor	SW17705	FL
2	1041C0700X	Clinical Social Worker	SW17705	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	:	1598365157
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAENEQUA BAKER LCSW

Provider Business Mailing Address
First Line	:	12348 HEALEY SUMMIT LN
Second Line	:
City	:	RIVERVIEW
State	:	FL
Zip	:	33579-7708
Country	:	US
Telephone Number	:	407-385-0196
Fax Number	:

Provider Business Practice Location Address
First Line	:	5118 N 56TH ST STE 111
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33610-5440
Country	:	US
Telephone Number	:	407-385-0196
Fax Number	:

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

Provider Enumeration Date	:	10/31/2020
Last Update Date	:	12/02/2022

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