Provider Demographics
NPI:1114258076
Name:BAUMGARDNER, BRIGITA SUNSHYNE (LCSW)
Entity type:Individual
Prefix:MS
First Name:BRIGITA
Middle Name:SUNSHYNE
Last Name:BAUMGARDNER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:BRIGITA
Other - Middle Name:S
Other - Last Name:DOTSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:294 SE CAMP ST
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32025-4415
Mailing Address - Country:US
Mailing Address - Phone:203-505-1293
Mailing Address - Fax:
Practice Address - Street 1:294 SE CAMP ST
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32025-4415
Practice Address - Country:US
Practice Address - Phone:203-505-1293
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-15
Last Update Date:2025-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0070111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical