Individual
CHRISTINE L TYRRELL-BAKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSYSHOLOGIST
Contact information
Practice address
220 HERALD PLACE, 4TH FLOOR, SYRACUSE, NY 13202-5002
(315) 472-7363
(315) 701-2368
Mailing address
220 HERALD PLACE, 4TH FLOOR, SYRACUSE, NY 13202-5002
(315) 472-7363
(315) 701-2368
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
014483
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
02994838
GRP MEDICAID
NY
01
—
1235184235
GRP NPI
—
01
—
BA1047
GRP MEDICARE
—
Enumeration date
10/20/2011
Last updated
10/21/2011
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