Healthcare Provider Details

I. General information

NPI: 1689879991
Provider Name (Legal Business Name): LISA MARCHAK BAKER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 CAMPMEETING RD
SEWICKLEY PA
15143-8773
US

IV. Provider business mailing address

2309 LAMBETH DR
PITTSBURGH PA
15241-2413
US

V. Phone/Fax

Practice location:
  • Phone: 412-749-2879
  • Fax: 412-741-1958
Mailing address:
  • Phone: 412-851-9572
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW013491L
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1419468
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerBLUE CROSS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: