Provider Demographics
NPI:1104130731
Name:BAKER, MELISSA (LMHC)
Entity type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:
Last Name:BAKER
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:72 GREGORY RD
Mailing Address - Street 2:
Mailing Address - City:HANNIBAL
Mailing Address - State:NY
Mailing Address - Zip Code:13074-2320
Mailing Address - Country:US
Mailing Address - Phone:315-532-3059
Mailing Address - Fax:
Practice Address - Street 1:62 WEST 9TH STREET
Practice Address - Street 2:
Practice Address - City:OSWEGO
Practice Address - State:NY
Practice Address - Zip Code:13126-2402
Practice Address - Country:US
Practice Address - Phone:315-532-3059
Practice Address - Fax:315-866-3236
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-06
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
NY005041101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health