Provider Demographics
NPI:1902426471
Name:BAKER, ALGERNON CORICO SR (PHD)
Entity Type:Individual
Prefix:
First Name:ALGERNON
Middle Name:CORICO
Last Name:BAKER
Suffix:SR
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1180 SEWELL LN
Mailing Address - Street 2:
Mailing Address - City:JENKINTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19046-1422
Mailing Address - Country:US
Mailing Address - Phone:215-830-1434
Mailing Address - Fax:
Practice Address - Street 1:2300 COMPUTER RD
Practice Address - Street 2:
Practice Address - City:WILLOW GROVE
Practice Address - State:PA
Practice Address - Zip Code:19090-1752
Practice Address - Country:US
Practice Address - Phone:215-830-1434
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-24
Last Update Date:2020-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist