Provider Demographics
NPI:1528089968
Name:BAUM, MARK SN (LCSW)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:SN
Last Name:BAUM
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 HICKS ST APT 24D
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-1685
Mailing Address - Country:US
Mailing Address - Phone:718-852-2891
Mailing Address - Fax:
Practice Address - Street 1:26 COURT ST STE 610
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11242-1106
Practice Address - Country:US
Practice Address - Phone:646-286-9806
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2008-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY072322-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical