| Organization Name: | MILDRED BAKER LCSW LLC |
| NPI Number: | 1790005429 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MILDRED BAKER (OFFICER) |
| Mailing Address: | 601 Wilson Ave Roaring Spring |
| State: | PA US |
| Postal Code: | 166731351 |
| Phone Number: | 8149340303 |
| Fax Number: | 8143170341 |
| NPI Enumeration Date: | 06/04/2010 |
| NPI Last Update Date: | 06/04/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | CW016550 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | PA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |