1790892362 NPI number — MRS. MARCIA MAY BAKER M.A.

Table of content: HEATHER OLSEN RN (NPI 1457591273)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790892362 NPI number — MRS. MARCIA MAY BAKER M.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BAKER
Provider First Name:
MARCIA
Provider Middle Name:
MAY
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M.A.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1790892362
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

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

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
150 BERKSHIRE RD.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RANGELEY
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04970-0223
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-864-3351
Provider Business Practice Location Address Fax Number:
207-864-3351
Provider Enumeration Date:
08/23/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  LCPC #591 LMFT #592 , registered in the state of ME ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 53983 . This is a "MAGELLAN HEALTH SERVICES" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: 2668197 . This is a "AETNA PIN" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: 4315535699 . This is a "MAINECARE THROUGH PROTEA" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: 358286 . This is a "KTRICARE" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: 003806 . This is a "ANTHEM BLUE CROSS" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".




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