Healthcare Provider Details

I. General information

NPI: 1568289858
Provider Name (Legal Business Name): EMILY BAKER BS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2024
Last Update Date: 09/26/2024
Certification Date: 09/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ST. RAPHAEL'S CAMPUS 330 ORCHARD STREET SUITE 107
NEW HAVEN CT
06511
US

IV. Provider business mailing address

ST. RAPHAEL'S CAMPUS 330 ORCHARD STREET SUITE 107
NEW HAVEN CT
06511
US

V. Phone/Fax

Practice location:
  • Phone: 203-200-4362
  • Fax: 203-200-1362
Mailing address:
  • Phone: 203-200-4362
  • Fax: 203-200-1362

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: