Individual
DR. THERESA E BAKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PSY.D.
Contact information
Practice address
501 CENTRE ST, FERNANDINA BEACH, FL 32034-3936
(904) 321-0121
Mailing address
501 CENTRE ST, FERNANDINA BEACH, FL 32034-3936
(904) 321-0121
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
6172
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
75324
BXBS - FL
FL
Enumeration date
08/30/2006
Last updated
07/08/2007
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