Provider Demographics
NPI:1801433685
Name:BAKER, MARICARMELLA A
Entity type:Individual
Prefix:
First Name:MARICARMELLA
Middle Name:A
Last Name:BAKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 FAIRWAY DR APT 302
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563-9106
Mailing Address - Country:US
Mailing Address - Phone:847-271-7873
Mailing Address - Fax:
Practice Address - Street 1:9944 S ROBERTS RD STE 202
Practice Address - Street 2:
Practice Address - City:PALOS HILLS
Practice Address - State:IL
Practice Address - Zip Code:60465-1558
Practice Address - Country:US
Practice Address - Phone:708-586-9050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-29
Last Update Date:2019-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional