Provider Demographics
NPI:1124240866
Name:BAIRD, JOHN SANFORD JR (PHD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:SANFORD
Last Name:BAIRD
Suffix:JR
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:11 SUNDALE DR
Mailing Address - Street 2:
Mailing Address - City:BLOOMSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17815-6942
Mailing Address - Country:US
Mailing Address - Phone:570-784-2051
Mailing Address - Fax:570-784-6292
Practice Address - Street 1:11 SUNDALE DR
Practice Address - Street 2:
Practice Address - City:BLOOMSBURG
Practice Address - State:PA
Practice Address - Zip Code:17815-6942
Practice Address - Country:US
Practice Address - Phone:570-784-2051
Practice Address - Fax:570-784-6292
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS002015-L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist