Basic Information
| Provider Information | |||||||||
| NPI: | 1992999411 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BAER | ||||||||
| FirstName: | GERALD | ||||||||
| MiddleName: | ALAN | ||||||||
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| Credential: | LCSW/LADC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1155 MILL ST | ||||||||
| Address2: | MAIL CODE K8 | ||||||||
| City: | RENO | ||||||||
| State: | NV | ||||||||
| PostalCode: | 895021576 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7759825756 | ||||||||
| FaxNumber: | 7759825240 | ||||||||
| Practice Location | |||||||||
| Address1: | 850 MILL ST | ||||||||
| Address2: | STE 301 | ||||||||
| City: | RENO | ||||||||
| State: | NV | ||||||||
| PostalCode: | 895021484 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7759825756 | ||||||||
| FaxNumber: | 7759825240 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/28/2007 | ||||||||
| LastUpdateDate: | 11/21/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 4541-C | NV | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 12176157 | 01 | CAQH | OTHER |