Healthcare Provider Details

I. General information

NPI: 1770541237
Provider Name (Legal Business Name): MILDRED F. BAKER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 02/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

328 BASSLER ST
MARTINSBURG PA
16662-1417
US

IV. Provider business mailing address

328 BASSLER ST
MARTINSBURG PA
16662-1417
US

V. Phone/Fax

Practice location:
  • Phone: 814-934-0303
  • Fax: 814-793-0916
Mailing address:
  • Phone: 814-934-0303
  • Fax: 814-793-0916

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCW016550
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: