Provider Demographics
NPI:1588353031
Name:BAUER, DAVID MORITZ (LCPC, CADC)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:MORITZ
Last Name:BAUER
Suffix:
Gender:M
Credentials:LCPC, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 WOODWARD AVE
Mailing Address - Street 2:
Mailing Address - City:GENEVA
Mailing Address - State:IL
Mailing Address - Zip Code:60134-1420
Mailing Address - Country:US
Mailing Address - Phone:630-430-4310
Mailing Address - Fax:
Practice Address - Street 1:117 FLINN ST
Practice Address - Street 2:
Practice Address - City:BATAVIA
Practice Address - State:IL
Practice Address - Zip Code:60510-2471
Practice Address - Country:US
Practice Address - Phone:224-803-2295
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-02
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.015827101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional