Provider Demographics
NPI:1245082577
Name:BAKER, BRENNAN MARION (LMSW)
Entity type:Individual
Prefix:
First Name:BRENNAN
Middle Name:MARION
Last Name:BAKER
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1731 SHEPHERD ST NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20011-5341
Mailing Address - Country:US
Mailing Address - Phone:706-766-2543
Mailing Address - Fax:
Practice Address - Street 1:1133 21ST ST NW FL 6
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20036-3390
Practice Address - Country:US
Practice Address - Phone:706-766-2543
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-02
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLG2000024861041C0700X
MD293041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical