Provider Demographics
NPI:1548310519
Name:BAKER, WILLFORD S (LCSW)
Entity type:Individual
Prefix:
First Name:WILLFORD
Middle Name:S
Last Name:BAKER
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:FORD
Other - Middle Name:S
Other - Last Name:BAKER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:6161 PERKINS RD STE 2C
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70808-4119
Mailing Address - Country:US
Mailing Address - Phone:225-769-2770
Mailing Address - Fax:225-769-2700
Practice Address - Street 1:6161 PERKINS RD STE 2C
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-4119
Practice Address - Country:US
Practice Address - Phone:225-769-2770
Practice Address - Fax:225-769-2700
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA4481104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker