Provider Demographics
NPI:1861022865
Name:BAKER-SIROTY, LUCAS (PSYD)
Entity type:Individual
Prefix:DR
First Name:LUCAS
Middle Name:
Last Name:BAKER-SIROTY
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 380524
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02238-0524
Mailing Address - Country:US
Mailing Address - Phone:617-903-0878
Mailing Address - Fax:
Practice Address - Street 1:11 CHAPEL PL
Practice Address - Street 2:
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02481-3130
Practice Address - Country:US
Practice Address - Phone:781-235-4950
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-19
Last Update Date:2020-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA11179103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist