Provider Demographics
NPI:1396809794
Name:BAUMANN, FRED J (LMSW & MALLP)
Entity type:Individual
Prefix:MR
First Name:FRED
Middle Name:J
Last Name:BAUMANN
Suffix:
Gender:M
Credentials:LMSW & MALLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8062 ORTONVILLE RD
Mailing Address - Street 2:
Mailing Address - City:CLARKSTON
Mailing Address - State:MI
Mailing Address - Zip Code:48348-4456
Mailing Address - Country:US
Mailing Address - Phone:248-625-2970
Mailing Address - Fax:248-625-6829
Practice Address - Street 1:8062 ORTONVILLE RD
Practice Address - Street 2:
Practice Address - City:CLARKSTON
Practice Address - State:MI
Practice Address - Zip Code:48348-4456
Practice Address - Country:US
Practice Address - Phone:248-625-2970
Practice Address - Fax:248-625-6829
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301006566103TC1900X
MI68010122941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical