=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275782138
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TAMARA LEIGH BAKER PH.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/16/2008
-----------------------------------------------------
Last Update Date | 07/11/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2650 QUARRY LAKE DR STE 200
-----------------------------------------------------
City | BALTIMORE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21209-3756
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-757-2077
-----------------------------------------------------
Fax | 410-757-5184
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7 STODDARD CT
-----------------------------------------------------
City | SPARKS GLENCOE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21152-9367
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-471-3557
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | 03175
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------