Healthcare Provider Details

I. General information

NPI: 1861102451
Provider Name (Legal Business Name): HANAKO BAKER PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2022
Last Update Date: 02/27/2024
Certification Date: 02/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 FERRUM MOUNTAIN RD
FERRUM VA
24088-2939
US

IV. Provider business mailing address

PO BOX 9
LAUREL FORK VA
24352-0009
US

V. Phone/Fax

Practice location:
  • Phone: 540-365-4469
  • Fax:
Mailing address:
  • Phone: 276-398-2292
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number0810008033
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0810008033
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: