MEDICARE: MS. MARIA ANTOINETTE BAKER LCSW-A, MSW

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	1041C0700X	Clinical Social Worker	P007497	NC

General Provider Information

NPI Number	:	1831445451
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARIA ANTOINETTE BAKER LCSW-A, MSW

Provider Business Mailing Address
First Line	:	119 VILLAGE LN APT H
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27409-2537
Country	:	US
Telephone Number	:	704-621-6977
Fax Number	:	336-285-7178

Provider Business Practice Location Address
First Line	:	1 CENTERVIEW DR STE 307
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27407-3712
Country	:	US
Telephone Number	:	336-285-7176
Fax Number	:	336-285-7178

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

Provider Enumeration Date	:	08/01/2012
Last Update Date	:	08/01/2012

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