Provider Demographics
NPI:1225255102
Name:BARON, IDA SUE (PHD)
Entity type:Individual
Prefix:DR
First Name:IDA
Middle Name:SUE
Last Name:BARON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:IDA
Other - Middle Name:SUE
Other - Last Name:BARON-STARKE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:310 W END AVE # 16D
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-8146
Mailing Address - Country:US
Mailing Address - Phone:301-757-5885
Mailing Address - Fax:301-775-5885
Practice Address - Street 1:310 W END AVE # 16D
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-8146
Practice Address - Country:US
Practice Address - Phone:301-775-5885
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2024-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810002315103G00000X, 103TC0700X
MD02300103G00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist