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General NPI Number Information
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NPI Number | 1407109853
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Entity Type | Individual
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Provider Name | KACY L. BAKER LCSW
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Gender | Female
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Dates
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Enumeration Date | 10/23/2012
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Last Update Date | 02/19/2025
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Provider Practice Location Address
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Address Line | 700 BREAKFAST POINT BLVD
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City | PANAMA CITY BEACH
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State | FL
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Zip | 32407-2534
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Country | US
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Telephone | 850-766-1208
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Fax |
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Provider Business Mailing Address
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Address Line | 700 BREAKFAST POINT BLVD
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City | PANAMA CITY BEACH
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State | FL
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Zip | 32407-2534
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Country | US
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Telephone | 850-766-1208
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number | B260512878050
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | SW13033
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License Number State | FL
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