MEDICARE: STACIA HILLARY BAKER MSW, LCSW

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	156.0134044	VT
2	1041C0700X	Clinical Social Worker	228002	MA

General Provider Information

NPI Number	:	1669199410
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STACIA HILLARY BAKER MSW, LCSW

Provider Business Mailing Address
First Line	:	64 AIKEN ST APT 203
Second Line	:
City	:	SOUTH BURLINGTON
State	:	VT
Zip	:	05403-7978
Country	:	US
Telephone Number	:	617-953-9169
Fax Number	:

Provider Business Practice Location Address
First Line	:	64 AIKEN ST APT 203
Second Line	:
City	:	SOUTH BURLINGTON
State	:	VT
Zip	:	05403-7978
Country	:	US
Telephone Number	:	617-953-9169
Fax Number	:

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

Provider Enumeration Date	:	10/24/2022
Last Update Date	:	10/24/2022

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