1154495349 NPI number — NANCY E BAKER LICSW PC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154495349 NPI number — NANCY E BAKER LICSW PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NANCY E BAKER LICSW PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1154495349
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
186 BEAVER MEADOW RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORWICH
Provider Business Mailing Address State Name:
VT
Provider Business Mailing Address Postal Code:
05055
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
802-649-5636
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
186 BEAVER MEADOW RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORWICH
Provider Business Practice Location Address State Name:
VT
Provider Business Practice Location Address Postal Code:
05055
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
802-649-5636
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BAKER
Authorized Official First Name:
NANCY
Authorized Official Middle Name:
E
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
802-649-5636

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  3 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: 0890000102 , registered in the state of VT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: NBAK00059099 . This is a "BCBS OF VT" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".




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