Provider Demographics
NPI:1306913330
Name:BAUER, KENNETH B (MSW)
Entity type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:B
Last Name:BAUER
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1516 TREENEEDLE RD
Mailing Address - Street 2:
Mailing Address - City:POINT PLEASANT BORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08742-3451
Mailing Address - Country:US
Mailing Address - Phone:732-899-3092
Mailing Address - Fax:
Practice Address - Street 1:1111 ARNOLD AVE
Practice Address - Street 2:
Practice Address - City:POINT PLEASANT BORO
Practice Address - State:NJ
Practice Address - Zip Code:08742-2312
Practice Address - Country:US
Practice Address - Phone:732-899-0429
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC00166200101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ637149Medicare ID - Type Unspecified