Provider Demographics
NPI:1568470623
Name:BAKER, KATHARINE G X (PHD)
Entity type:Individual
Prefix:DR
First Name:KATHARINE
Middle Name:G
Last Name:BAKER
Suffix:X
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 KENSINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:NORTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01060-2905
Mailing Address - Country:US
Mailing Address - Phone:413-268-0111
Mailing Address - Fax:413-586-0215
Practice Address - Street 1:53 CENTER ST
Practice Address - Street 2:
Practice Address - City:NORTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01060-3000
Practice Address - Country:US
Practice Address - Phone:413-268-0111
Practice Address - Fax:413-586-0215
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1078281041C0700X
DCLC3003581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
BA P22822Medicare ID - Type Unspecified