Healthcare Provider Details

I. General information

NPI: 1558019802
Provider Name (Legal Business Name): RACHEL BAKER RCSWI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/15/2022
Last Update Date: 03/15/2022
Certification Date: 03/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 E LEMON ST STE 205
LAKELAND FL
33801-4627
US

IV. Provider business mailing address

1325 BRAMBLEWOOD DR
LAKELAND FL
33811-1546
US

V. Phone/Fax

Practice location:
  • Phone: 863-732-7200
  • Fax:
Mailing address:
  • Phone: 886-315-0080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number16195
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: