Healthcare Provider Details

I. General information

NPI: 1174710156
Provider Name (Legal Business Name): JEANNEMARIE BAKER, NP-PSYCHIATRY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2007
Last Update Date: 10/03/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

424 W 34TH ST LOWER LEVEL
NEW YORK NY
10001-2321
US

IV. Provider business mailing address

424 W 34TH ST LOWER LEVEL
NEW YORK NY
10001-2321
US

V. Phone/Fax

Practice location:
  • Phone: 212-695-3444
  • Fax: 212-695-0242
Mailing address:
  • Phone: 212-695-3444
  • Fax: 212-695-0242

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number
License Number State

VIII. Authorized Official

Name: JEANNEMARIE BAKER
Title or Position: EXECUTIVE DIRECTOR
Credential: NP-P
Phone: 212-695-3444