Healthcare Provider Details

I. General information

NPI: 1053505974
Provider Name (Legal Business Name): ANTOINETTE LOUISE BAKER-MULFORD LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TONI LOUISE MULFORD LCSW

II. Dates (important events)

Enumeration Date: 09/04/2007
Last Update Date: 03/26/2021
Certification Date: 03/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5100 PEACH ST
ERIE PA
16509
US

IV. Provider business mailing address

1330 W 26TH ST
ERIE PA
16508-1402
US

V. Phone/Fax

Practice location:
  • Phone: 814-866-4500
  • Fax: 814-866-2677
Mailing address:
  • Phone: 814-459-9300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW015204
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: