MEDICARE: MRS. MARCIA MAY BAKER M.A.

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	101YM0800X	Mental Health Counselor	LCPC #591 LMFT #592	ME

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	53983	OTHER	ME	MAGELLAN HEALTH SERVICES
2	2668197	OTHER	ME	AETNA PIN
3	4315535699	OTHER	ME	MAINECARE THROUGH PROTEA
4	358286	OTHER	ME	KTRICARE
5	003806	OTHER	ME	ANTHEM BLUE CROSS

General Provider Information

NPI Number	:	1790892362
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARCIA MAY BAKER M.A.

Provider Business Mailing Address
First Line	:	PO BOX 223
Second Line	:	150 BERKSHIRE RD.
City	:	RANGELEY
State	:	ME
Zip	:	04970-0223
Country	:	US
Telephone Number	:	207-864-3351
Fax Number	:	207-864-3351

Provider Business Practice Location Address
First Line	:	150 BERKSHIRE RD.
Second Line	:
City	:	RANGELEY
State	:	ME
Zip	:	04970-0223
Country	:	US
Telephone Number	:	207-864-3351
Fax Number	:	207-864-3351

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

Provider Enumeration Date	:	08/23/2006
Last Update Date	:	07/08/2007

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