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DR. MARY J BAKER-ERICZEN PHD
NPI 1144330382
Psychologist - Intellectual and Developmental Disabilities in San Diego, CA

Active since August 30, 2006PECOS Enrolled
3990 OLD TOWN AVE STE A207, SAN DIEGO, CA 92110(858) 699-7978 Get Directions Write a Review

NPPES record last updated: September 11, 2025. Verified against the NPPES registry weekly; last sync: July 19, 2026.

About Dr. Mary J Baker-ericzen Phd NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. MARY J BAKER-ERICZEN PHD (NPI 1144330382) is an individual intellectual and developmental disabilities provider in San Diego, California, licensed in California (PSY17553) and active in the NPI registry since August 2006. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1144330382
Entity TypeIndividualFemale
Primary Taxonomy103TM1800X
Provider Legal NameDR. MARY J BAKER-ERICZENCredential: PHD
Location Address3990 OLD TOWN AVE STE A207San Diego, CA 92110-2967
Mailing Address3990 Old Town Ave Ste A207San Diego, CA 92110-2967 · (858) 699-7978
Phone(858) 699-7978
Sole ProprietorYes
Enumeration DateAugust 30, 2006
Last NPPES UpdateSeptember 11, 2025
✔ NPI 1144330382 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyPsychologist · Intellectual and Developmental DisabilitiesBehavioral Health & Social Service Providers
Taxonomy Code103TM1800X
License✔ Licensed in CA · PSY17553
Also ListedPsychologist · Clinical Child & AdolescentTaxonomy 103TC2200X · License PSY17553 (CA)
3990 OLD TOWN AVE STE A207, San Diego, CA 92110
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

ⓘ

Opted out of Medicare

Dr. Mary J Baker-ericzen Phd has filed a Medicare opt-out affidavit. Services are provided under private contract between the provider and the patient, and are not billed to or reimbursed by Medicare. The opt-out is on file from March 20, 2022 through March 20, 2026.

Opt-Out Effective DateMarch 20, 2022
Opt-Out In Effect ThroughMarch 20, 2026Opt-out affidavits renew automatically every two years unless cancelled
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment– Home Health Agency– Power Mobility DevicesAn opted-out provider can still order and refer for Medicare patients in the categories marked above, even though their own services are not covered.

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

INTRICATE MIND INSTITUTE, LLC
Psychologist (Cognitive & Behavioral)
3990 OLD TOWN AVE STE A207
SAN DIEGO, CA 92110
San Diego County (858) 205-9809

Frequently Asked Questions

What is Mary Baker-ericzen's NPI number?

The NPI number assigned to this healthcare provider is 1144330382, enumerated as an "individual" on August 30, 2006.

Where is the provider located?

The provider is located at 3990 OLD TOWN AVE STE A207 SAN DIEGO, CA 92110 and the phone number is (858) 699-7978.

What is the provider's specialty?

Psychologist with taxonomy code 103TM1800X and a focus in Intellectual and Developmental Disabilities.