Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 0810005233 | VA |
Y | 103TC0700X | Clinical Psychologist | 0810005233 | VA |
NPI | 1003137688 |
---|---|
Provider Name | Dr. Justin C Baker |
First Address | Camp Lejeune, NC 28547-2538 |
Second Address | Camp Lejeune, NC 28547-2538 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/06/2010 |
Last Update Date | 20/11/2015 |