Healthcare Provider Details

I. General information

NPI: 1316241250
Provider Name (Legal Business Name): DOROTHY PUTNAM-BAKER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/07/2011
Last Update Date: 10/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

122 W LANCASTER AVE STE 205
SHILLINGTON PA
19607-1874
US

IV. Provider business mailing address

1325 GARFIELD AVE
WYOMISSING PA
19610
US

V. Phone/Fax

Practice location:
  • Phone: 484-588-4131
  • Fax:
Mailing address:
  • Phone: 610-804-8909
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW016825
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: