Provider Demographics
NPI:1285757617
Name:BAUMGARTEN, BRUCE STEPHEN (PHD)
Entity type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:STEPHEN
Last Name:BAUMGARTEN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 KATHLEEN DR
Mailing Address - Street 2:
Mailing Address - City:SYOSSET
Mailing Address - State:NY
Mailing Address - Zip Code:11791-5816
Mailing Address - Country:US
Mailing Address - Phone:516-496-9885
Mailing Address - Fax:516-496-9885
Practice Address - Street 1:26 BERRY HILL RD
Practice Address - Street 2:
Practice Address - City:SYOSSET
Practice Address - State:NY
Practice Address - Zip Code:11791-2623
Practice Address - Country:US
Practice Address - Phone:516-733-0368
Practice Address - Fax:516-496-9885
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2015-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012801103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral