MEDICARE: BAIRD PSYCHOTHERAPY SERVICES, LLC

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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1659872554
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BAIRD PSYCHOTHERAPY SERVICES, LLC

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

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	:	OWNER
Name	:	LOLA BAIRD
Credential	:	LICSW
Telephone Number	:	857-264-1447

Provider Enumeration Date	:	02/26/2018
Last Update Date	:	02/26/2018

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