Provider Demographics
NPI:1104123439
Name:BAKER, MONIQUE (BCABA)
Entity type:Individual
Prefix:
First Name:MONIQUE
Middle Name:
Last Name:BAKER
Suffix:
Gender:F
Credentials:BCABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1150 SE MAYNARD RD
Mailing Address - Street 2:SUITE 140
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27511-4164
Mailing Address - Country:US
Mailing Address - Phone:919-371-2848
Mailing Address - Fax:919-467-6777
Practice Address - Street 1:1150 SE MAYNARD RD
Practice Address - Street 2:SUITE 140
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511-4164
Practice Address - Country:US
Practice Address - Phone:919-371-2848
Practice Address - Fax:919-467-6777
Is Sole Proprietor?:No
Enumeration Date:2011-02-23
Last Update Date:2011-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst