Healthcare Provider Details

I. General information

NPI: 1295014439
Provider Name (Legal Business Name): CLARISSA BAKER RN, CMHN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2011
Last Update Date: 08/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 N PARK ST
SENECA FALLS NY
13148-1437
US

IV. Provider business mailing address

12 N PARK ST
SENECA FALLS NY
13148-1437
US

V. Phone/Fax

Practice location:
  • Phone: 315-568-9412
  • Fax: 315-568-2241
Mailing address:
  • Phone: 315-568-9412
  • Fax: 315-568-2241

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number438976
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: