Provider Demographics
NPI:1962782789
Name:BAKER, BETH M (LMT)
Entity type:Individual
Prefix:MS
First Name:BETH
Middle Name:M
Last Name:BAKER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 LINDEN ST
Mailing Address - Street 2:407
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02170-1823
Mailing Address - Country:US
Mailing Address - Phone:857-939-3827
Mailing Address - Fax:
Practice Address - Street 1:67 CODDINGTON ST STE 103
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-4511
Practice Address - Country:US
Practice Address - Phone:617-481-1280
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-24
Last Update Date:2011-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA655174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist