MEDICARE: JOHN WILLIAM BAKER II PH.D.

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	003483-1	NY

General Provider Information

NPI Number	:	1821108879
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN WILLIAM BAKER II PH.D.

Provider Business Mailing Address
First Line	:	3212 US ROUTE 9W
Second Line	:
City	:	NEW WINDSOR
State	:	NY
Zip	:	12553-6756
Country	:	US
Telephone Number	:	845-565-8790
Fax Number	:	845-565-5730

Provider Business Practice Location Address
First Line	:	3212 US ROUTE 9W
Second Line	:
City	:	NEW WINDSOR
State	:	NY
Zip	:	12553-6756
Country	:	US
Telephone Number	:	845-565-8790
Fax Number	:	845-565-5730

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

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	07/08/2007

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