Provider Demographics
NPI:1306050554
Name:BAKEROFSKIE, JOHN ALBERT (MA)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:ALBERT
Last Name:BAKEROFSKIE
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3940 LOCUST LN
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17109-4023
Mailing Address - Country:US
Mailing Address - Phone:570-294-3448
Mailing Address - Fax:
Practice Address - Street 1:1287 COUNTY WELFARE RD
Practice Address - Street 2:
Practice Address - City:LEESPORT
Practice Address - State:PA
Practice Address - Zip Code:19533-9197
Practice Address - Country:US
Practice Address - Phone:610-208-4800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health