Provider Demographics
NPI:1912581919
Name:BAUER, THERESA ANTIMA (MS, LMFT)
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:ANTIMA
Last Name:BAUER
Suffix:
Gender:
Credentials:MS, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4853 PLUM RUN CT
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19808-1715
Mailing Address - Country:US
Mailing Address - Phone:941-626-7805
Mailing Address - Fax:
Practice Address - Street 1:261 CHAPMAN RD
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19702-5423
Practice Address - Country:US
Practice Address - Phone:302-455-9333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-06
Last Update Date:2025-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT4857106H00000X
DEFT0010163106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist