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General NPI Number Information
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NPI Number | 1285122432
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Entity Type | Organization
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Legal Business Name | JEAN M BAKER
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Dates
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Enumeration Date | 04/24/2018
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Last Update Date | 04/24/2018
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Provider Practice Location Address
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Address Line | 3 FOUNTAIN ST STE 201
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City | CLINTON
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State | NY
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Zip | 13323-1747
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Country | US
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Telephone | 315-292-4834
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Fax | 315-266-1366
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Provider Business Mailing Address
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Address Line | 3 FOUNTAIN ST STE 201
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City | CLINTON
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State | NY
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Zip | 13323-1747
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Country | US
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Telephone | 315-292-4834
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Fax | 315-266-1366
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Authorized Official
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Title or Position | MANAGER/PRACTITIONER
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Name | JEAN M BAKER
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Credential | LCSW-R
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Telephone | 315-292-4834
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | R058181
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License Number State | NY
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