Healthcare Provider Details

I. General information

NPI: 1598848483
Provider Name (Legal Business Name): ELIZABETH J. BAKER PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

385 WAVERLEY AVE
NEWTON MA
02458-2720
US

IV. Provider business mailing address

385 WAVERLEY AVE
NEWTON MA
02458-2720
US

V. Phone/Fax

Practice location:
  • Phone: 617-332-4518
  • Fax:
Mailing address:
  • Phone: 617-332-4518
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number2992
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number2992
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: