Provider Demographics
NPI:1386413490
Name:BAKER, SANDRA DEE (LMSW)
Entity type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:DEE
Last Name:BAKER
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:MISS
Other - First Name:SANDRA
Other - Middle Name:DEE
Other - Last Name:FULGHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:90 LISA DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH WINDSOR
Mailing Address - State:CT
Mailing Address - Zip Code:06074-1836
Mailing Address - Country:US
Mailing Address - Phone:860-461-6695
Mailing Address - Fax:
Practice Address - Street 1:90 LISA DR
Practice Address - Street 2:
Practice Address - City:SOUTH WINDSOR
Practice Address - State:CT
Practice Address - Zip Code:06074-1836
Practice Address - Country:US
Practice Address - Phone:860-461-6695
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-29
Last Update Date:2023-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT93731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical