Healthcare Provider Details

I. General information

NPI: 1548815806
Provider Name (Legal Business Name): MATTHEW BAKER LPC, LCADC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2019
Last Update Date: 01/31/2023
Certification Date: 01/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1198 LAKEWOOD RD
TOMS RIVER NJ
08753-2237
US

IV. Provider business mailing address

1198 LAKEWOOD RD
TOMS RIVER NJ
08753-2237
US

V. Phone/Fax

Practice location:
  • Phone: 732-736-6559
  • Fax:
Mailing address:
  • Phone: 732-736-6559
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number37CA00141400
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number37LC00323800
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number37AC00538000
License Number StateNJ
# 4
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number37PC00887300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: