Provider Demographics
NPI:1336614544
Name:BAKER, SANDY (LMHC)
Entity type:Individual
Prefix:
First Name:SANDY
Middle Name:
Last Name:BAKER
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:SANDY
Other - Middle Name:
Other - Last Name:BAKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:50 GLEN ST STE 232
Mailing Address - Street 2:
Mailing Address - City:GLEN COVE
Mailing Address - State:NY
Mailing Address - Zip Code:11542-4304
Mailing Address - Country:US
Mailing Address - Phone:516-669-9188
Mailing Address - Fax:
Practice Address - Street 1:50 GLEN ST STE 232
Practice Address - Street 2:
Practice Address - City:GLEN COVE
Practice Address - State:NY
Practice Address - Zip Code:11542-4304
Practice Address - Country:US
Practice Address - Phone:516-234-6938
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-04
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012622101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY231110117Medicaid
NONEOtherNONE