=====================================================
General NPI Number Information
=====================================================
NPI Number | 1861773293
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JAMES BAXTER LCSW
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/30/2011
-----------------------------------------------------
Last Update Date | 08/30/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 900 DUTCHESS TPKE
-----------------------------------------------------
City | POUGHKEEPSIE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12603-1554
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-486-4840
-----------------------------------------------------
Fax | 845-486-4831
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1040 FREEDOM RD
-----------------------------------------------------
City | PLEASANT VALLEY
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12569-7636
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-635-8521
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | PR020418-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------