Basic Information
| Provider Information | |||||||||
| NPI: | 1699027318 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MOMOT-BAKER | ||||||||
| FirstName: | MARGARET | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
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| Credential: | PH.D | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | MOMOT | ||||||||
| OtherFirstName: | MARGARET | ||||||||
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| OtherCredential: | PH.D | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 303 MERRICK RD | ||||||||
| Address2: | SUITE 204 | ||||||||
| City: | LYNBROOK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 115632501 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8007256280 | ||||||||
| FaxNumber: | 8007256380 | ||||||||
| Practice Location | |||||||||
| Address1: | 1070 LUTHER RD | ||||||||
| Address2: | |||||||||
| City: | EAST GREENBUSH | ||||||||
| State: | NY | ||||||||
| PostalCode: | 120614020 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5184794662 | ||||||||
| FaxNumber: | 5184774465 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/04/2012 | ||||||||
| LastUpdateDate: | 10/04/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | 019456 | NY | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.