Provider Demographics
NPI:1447365077
Name:BAKER, DOUGLAS C (LICSW)
Entity type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:C
Last Name:BAKER
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:DOUGLAS
Other - Middle Name:C
Other - Last Name:BAKER PUTTINI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:395 BROADWAY
Mailing Address - Street 2:#L3E
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02139
Mailing Address - Country:US
Mailing Address - Phone:617-497-1006
Mailing Address - Fax:
Practice Address - Street 1:11 BELLIS CIRCLE
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02140
Practice Address - Country:US
Practice Address - Phone:617-331-4654
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1136491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical