Provider Demographics
NPI:1992741243
Name:SOBKO BAKER, NATALIA (LCSW)
Entity type:Individual
Prefix:
First Name:NATALIA
Middle Name:
Last Name:SOBKO BAKER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:949 BRIDGEPORT AVENUE
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06460-3142
Mailing Address - Country:US
Mailing Address - Phone:203-878-6365
Mailing Address - Fax:
Practice Address - Street 1:949 BRIDGEPORT AVENUE
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06460-3142
Practice Address - Country:US
Practice Address - Phone:203-878-6365
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-22
Last Update Date:2011-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0032511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004039244Medicaid
CT279247OtherMANAGED HEALTH NETWORK
CT000211686OtherUNITED BEHAVIORAL HEALTH
CT140003251CT01OtherANTHEM BEHAVIORAL HEALTH
CT268815OtherCOM PSYCH
CT800002869Medicare PIN