Active NPI
Kurt Dayne Baker, PH.D.
- Clinical Psychologist
- Modesto, CA
National Provider Identifier
1003976861
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PSY20518
- Practice address
- 4125 Bangs Ave
Modesto, CA 95356-8713 - Phone
- (209) 557-2300
- NPI assigned
- Dec 11, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | PSY20518 | CA | Primary |
Addresses
Primary practice location
4125 Bangs Ave
Modesto, CA 95356-8713
Mailing address
801 W Monte Vista Ave
Dept of Psychology, Cal State University, Stanislaus
Turlock, CA 95382-0256
Phone (209) 664-6681
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1016 | KS | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1165795200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1003976861",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "801 W MONTE VISTA AVE",
"address_2": "DEPT OF PSYCHOLOGY, CAL STATE UNIVERSITY, STANISLAUS",
"city": "TURLOCK",
"state": "CA",
"postal_code": "953820256",
"telephone_number": "209-664-6681"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4125 BANGS AVE",
"city": "MODESTO",
"state": "CA",
"postal_code": "953568713",
"telephone_number": "209-557-2300"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BAKER",
"first_name": "KURT",
"middle_name": "DAYNE",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-12-11",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "PSY20518",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Modesto, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.