Provider Demographics
NPI:1861773293
Name:BAXTER, JAMES (LCSW)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:
Last Name:BAXTER
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1040 FREEDOM RD
Mailing Address - Street 2:
Mailing Address - City:PLEASANT VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:12569-7636
Mailing Address - Country:US
Mailing Address - Phone:845-635-8521
Mailing Address - Fax:
Practice Address - Street 1:900 DUTCHESS TPKE
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12603-1554
Practice Address - Country:US
Practice Address - Phone:845-486-4840
Practice Address - Fax:845-486-4831
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-30
Last Update Date:2011-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPR020418-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical