Provider Demographics
NPI:1851648992
Name:BAUMGARDT, GAYLA A (LCSW)
Entity type:Individual
Prefix:MRS
First Name:GAYLA
Middle Name:A
Last Name:BAUMGARDT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 ASCOT
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23188-9181
Mailing Address - Country:US
Mailing Address - Phone:757-234-2409
Mailing Address - Fax:
Practice Address - Street 1:104 ASCOT
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23188-9181
Practice Address - Country:US
Practice Address - Phone:757-234-2409
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-08
Last Update Date:2022-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC500783371041C0700X
VA09040114181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical