MEDICARE: DANIELA DE VASQUES BAKER PSYD

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	101Y00000X	Counselor
2	101YM0800X	Mental Health Counselor
3	390200000X	Student in an Organized Health Care Education/Training Program
4	103T00000X	Psychologist	26897	CA

General Provider Information

NPI Number	:	1427112408
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIELA DE VASQUES BAKER PSYD

Provider Business Mailing Address
First Line	:	4865 OLD REDWOOD HWY STE 102
Second Line	:
City	:	SANTA ROSA
State	:	CA
Zip	:	95403-1415
Country	:	US
Telephone Number	:	415-254-3797
Fax Number	:

Provider Business Practice Location Address
First Line	:	4865 OLD REDWOOD HWY STE 102
Second Line	:
City	:	SANTA ROSA
State	:	CA
Zip	:	95403-1415
Country	:	US
Telephone Number	:	415-254-3797
Fax Number	:

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

Provider Enumeration Date	:	12/21/2006
Last Update Date	:	02/14/2025

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