Jack David Baker, PHD

Primary specialty

PsychologistTaxonomy code 103T00000X

Practice address

1530 Wilson Blvd Ste 360
Arlington, VA 22209-2466

Phone

(571) 534-3825

NPI assigned

Oct 17, 2019

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Nov 14, 2022 through Nov 14, 2026

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Nouveau Psychological Wellness, PLLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Arlington, VA
  • NPI 1326814484
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1571270400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1710374400000",
    "number": "1073155453",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1530 WILSON BLVD STE 360",
            "city": "ARLINGTON",
            "state": "VA",
            "postal_code": "222092466"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1530 WILSON BLVD STE 360",
            "city": "ARLINGTON",
            "state": "VA",
            "postal_code": "222092466",
            "telephone_number": "571-534-3825"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BAKER",
        "first_name": "JACK",
        "middle_name": "DAVID",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-10-17",
        "last_updated": "2024-03-14",
        "certification_date": "2024-03-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Bahareh Bahador, M.D.
• Bhagwan A Bahroo, M.D.
• Baik, Duong, Ma, Nguyen & Associates
• Carole Frances Baker, MSW LCSW
• Elizabeth Baker
• Lauren Kimberly Baker, ATC
• Tracy Anne Baker, PT
• Bal Therapy LLC
• Jack E Bal Jr., PT, DPT
• Jessica Victoria Balagtas, DNP, FNP

• Psychologist in Arlington, VA
• Providers in Arlington, VA by specialty
• Psychologist in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 14, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.