Provider Demographics
NPI:1346398195
Name:BAKER, KIMBERLY FITZGIBBON (LMHC)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:FITZGIBBON
Last Name:BAKER
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:MISS
Other - First Name:KIMBERLY
Other - Middle Name:ANN
Other - Last Name:FITZGIBBON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMHC
Mailing Address - Street 1:2687 WENDE RD
Mailing Address - Street 2:
Mailing Address - City:ALDEN
Mailing Address - State:NY
Mailing Address - Zip Code:14004-9789
Mailing Address - Country:US
Mailing Address - Phone:716-983-0053
Mailing Address - Fax:
Practice Address - Street 1:2687 WENDE RD
Practice Address - Street 2:
Practice Address - City:ALDEN
Practice Address - State:NY
Practice Address - Zip Code:14004-9789
Practice Address - Country:US
Practice Address - Phone:167-902-5266
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2020-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001426101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health