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Individual

DORETHA MICHELLE BAKER

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
CASAC

Contact information

Practice address
165 MAIN ST STE A, CORTLAND, NY 13045-3049
(607) 753-0234
Mailing address
165 MAIN ST STE A, CORTLAND, NY 13045-3049
(607) 753-0234

Taxonomy

Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
CASAC2-27390
NY

Other

Enumeration date
09/04/2018
Last updated
09/04/2018
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