Provider Demographics
NPI:1306280516
Name:BAKER, ROBERT THOMAS III (PSYD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:THOMAS
Last Name:BAKER
Suffix:III
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5315 N CLARK ST
Mailing Address - Street 2:#319
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-2290
Mailing Address - Country:US
Mailing Address - Phone:847-331-4600
Mailing Address - Fax:
Practice Address - Street 1:5412 N CLARK ST
Practice Address - Street 2:#210
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-1223
Practice Address - Country:US
Practice Address - Phone:847-331-4600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-18
Last Update Date:2013-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071006239103TC0700X
IN20041586A103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical