Healthcare Provider Details

I. General information

NPI: 1952634404
Provider Name (Legal Business Name): LEWIE EVAN BAKER MSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2009
Last Update Date: 09/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

919 RENCHER ST
CLOVIS NM
88101-5858
US

IV. Provider business mailing address

919 RENCHER ST
CLOVIS NM
88101-5858
US

V. Phone/Fax

Practice location:
  • Phone: 575-769-2142
  • Fax: 575-769-2162
Mailing address:
  • Phone: 575-769-2142
  • Fax: 575-769-2162

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: