Healthcare Provider Details

I. General information

NPI: 1467186569
Provider Name (Legal Business Name): RACHEL A BAKER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2022
Last Update Date: 04/10/2024
Certification Date: 03/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 GRAMPIAN BLVD
WILLIAMSPORT PA
17701-1907
US

IV. Provider business mailing address

2480 EDERCREST RD
WILLIAMSPORT PA
17701-4078
US

V. Phone/Fax

Practice location:
  • Phone: 570-320-7525
  • Fax:
Mailing address:
  • Phone: 570-971-4379
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSW130363
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW024336
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: