Provider Demographics
NPI:1285122432
Name:JEAN M BAKER
Entity type:Organization
Organization Name:JEAN M BAKER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-R
Authorized Official - Phone:315-292-4834
Mailing Address - Street 1:3 FOUNTAIN ST STE 201
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:NY
Mailing Address - Zip Code:13323-1747
Mailing Address - Country:US
Mailing Address - Phone:315-292-4834
Mailing Address - Fax:315-266-1366
Practice Address - Street 1:3 FOUNTAIN ST STE 201
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:NY
Practice Address - Zip Code:13323-1747
Practice Address - Country:US
Practice Address - Phone:315-292-4834
Practice Address - Fax:315-266-1366
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-24
Last Update Date:2018-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0581811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty