Provider Demographics
NPI:1790663011
Name:BAKER, BENJAMIN TRAVIS (CPSS, AMHSW, ASW)
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:TRAVIS
Last Name:BAKER
Suffix:
Gender:M
Credentials:CPSS, AMHSW, ASW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6830 N 55TH AVE STE 100B
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85301-3304
Mailing Address - Country:US
Mailing Address - Phone:623-307-7493
Mailing Address - Fax:
Practice Address - Street 1:6830 N 55TH AVE STE 100B
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85301-3304
Practice Address - Country:US
Practice Address - Phone:623-307-7493
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-25
Last Update Date:2025-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker