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General NPI Number Information
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NPI Number | 1922160555
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Entity Type | Individual
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Provider Name | MANDY CRYSTAL BAKER LMHC
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Gender | Female
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Dates
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Enumeration Date | 12/13/2006
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Last Update Date | 03/08/2022
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Provider Practice Location Address
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Address Line | 8 HILLVIEW DRIVE
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City | NORTH PROVIDENCE
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State | RI
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Zip | 02904
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Country | US
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Telephone | 508-216-0077
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Fax | 508-507-3350
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Provider Business Mailing Address
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Address Line | 371 POTNAM PIKE STE 230 PMB 1003
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City | SMITHFIELD
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State | RI
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Zip | 02917
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Country | US
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Telephone | 508-216-0077
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Fax | 508-507-3350
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | MCH00986
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License Number State | RI
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Taxonomy #2
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 6157
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License Number State | MA
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Taxonomy #3
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 6157
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License Number State | MA
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