Provider Demographics
NPI:1992930184
Name:BAKER, TANYA CHRISTINE (LMSW, LPN)
Entity type:Individual
Prefix:MRS
First Name:TANYA
Middle Name:CHRISTINE
Last Name:BAKER
Suffix:
Gender:F
Credentials:LMSW, LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 STATE ROUTE 96
Mailing Address - Street 2:
Mailing Address - City:PHELPS
Mailing Address - State:NY
Mailing Address - Zip Code:14532-9532
Mailing Address - Country:US
Mailing Address - Phone:315-548-8079
Mailing Address - Fax:315-548-8079
Practice Address - Street 1:615 STATE ROUTE 96
Practice Address - Street 2:
Practice Address - City:PHELPS
Practice Address - State:NY
Practice Address - Zip Code:14532-9532
Practice Address - Country:US
Practice Address - Phone:315-548-8079
Practice Address - Fax:315-548-8079
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-18
Last Update Date:2018-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY218485-1164W00000X
NY103066-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02814097Medicaid