Provider Demographics
NPI:1174615009
Name:BAER, PATRICIA (LMSW)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:BAER
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 LAKEVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49424-2250
Mailing Address - Country:US
Mailing Address - Phone:616-392-6116
Mailing Address - Fax:616-399-6335
Practice Address - Street 1:36 W 8TH ST
Practice Address - Street 2:SUITE 250
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49423-2708
Practice Address - Country:US
Practice Address - Phone:616-392-6116
Practice Address - Fax:616-399-6335
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010626141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MION29540Medicare PIN