Mary J Baker-Ericzen, PHD

Primary specialty

Intellectual & Developmental Disabilities PsychologistTaxonomy code 103TM1800X

License

PSY17553 Issued in CA

Practice address

3990 Old Town Ave Ste A207
San Diego, CA 92110-2967

Phone

(858) 699-7978

NPI assigned

Aug 30, 2006

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Mar 20, 2022 through Mar 20, 2028

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

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.

• Intricate Mind Institute, LLC

  • Cognitive & Behavioral Psychologist
  • San Diego, CA
  • NPI 1457638124

  Intellectual & Developmental Disabilities

  NPD (past) Authorized official

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

{
    "created_epoch": "1156896000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1757548800000",
    "number": "1144330382",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3990 OLD TOWN AVE STE A207",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921102967",
            "telephone_number": "858-699-7978"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3990 OLD TOWN AVE STE A207",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921102967",
            "telephone_number": "858-699-7978"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BAKER-ERICZEN",
        "first_name": "MARY",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-08-30",
        "last_updated": "2025-09-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC2200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": "CA",
            "license": "PSY17553",
            "primary": false
        },
        {
            "code": "103TM1800X",
            "taxonomy_group": "",
            "desc": "Psychologist, Intellectual & Developmental Disabilities",
            "state": "CA",
            "license": "PSY17553",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mandeep Singh Bajwa, MD
• Marie-Louise Bakala
• Roberto C Bakani, LVN
• Ryan K Baker-Barrett, BCBA
• Mary Baker-Dove, RN, MS, MSN, MHCNS-B
• Hazel Teresa Baker-Harvey
• Alexandra Baker, RN
• Angel Baker, LCSW
• Ashlee Baker
• Ashley Lauren Baker

• Intellectual & Developmental Disabilities Psychologist in San Diego, CA
• Providers in San Diego, CA by specialty
• Intellectual & Developmental Disabilities Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.