Provider Demographics
NPI:1225330467
Name:BAKER-BARRETT, RYAN K (BCBA)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:K
Last Name:BAKER-BARRETT
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:RYAN
Other - Middle Name:K
Other - Last Name:KNIGHTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BCBA
Mailing Address - Street 1:105 HOLT ST
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02472-1019
Mailing Address - Country:US
Mailing Address - Phone:435-363-6789
Mailing Address - Fax:
Practice Address - Street 1:105 HOLT ST
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:MA
Practice Address - Zip Code:02472-1019
Practice Address - Country:US
Practice Address - Phone:435-363-6789
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-19
Last Update Date:2024-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALABA2370103K00000X
1-12-12588103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst