MEDICARE: LOLA K BAIRD LICSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	117737	MA

General Provider Information

NPI Number	:	1376870949
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LOLA K BAIRD LICSW

Provider Business Mailing Address
First Line	:	940 BELMONT ST
Second Line	:
City	:	BROCKTON
State	:	MA
Zip	:	02301-5596
Country	:	US
Telephone Number	:	774-826-1902
Fax Number	:	774-826-2580

Provider Business Practice Location Address
First Line	:	1430 MASSACHUSETTS AVE FL 5
Second Line	:
City	:	CAMBRIDGE
State	:	MA
Zip	:	02138-3831
Country	:	US
Telephone Number	:	857-264-1447
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/03/2009
Last Update Date	:	03/17/2018

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