Provider Demographics
NPI:1386747996
Name:BAKER, PATRICIA JANE (MARRIAGE & FAMILY TH)
Entity type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:JANE
Last Name:BAKER
Suffix:
Gender:F
Credentials:MARRIAGE & FAMILY TH
Other - Prefix:MS
Other - First Name:PATRICIA
Other - Middle Name:LUTHER
Other - Last Name:BAKER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MARRIAGE & FAMILY TH
Mailing Address - Street 1:20833 STEVENS CREEK BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CUPERTINO
Mailing Address - State:CA
Mailing Address - Zip Code:95014
Mailing Address - Country:US
Mailing Address - Phone:408-873-1592
Mailing Address - Fax:408-342-0617
Practice Address - Street 1:20833 STEVENS CREEK BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:CUPERTINO
Practice Address - State:CA
Practice Address - Zip Code:95014
Practice Address - Country:US
Practice Address - Phone:408-873-1592
Practice Address - Fax:408-342-0617
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC14464106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ8712ZOtherBLUE SHIELD BLUE CROSS
CAID067117OtherMENTAL HEALTH NETWORK