Healthcare Provider Details

I. General information

NPI: 1598070393
Provider Name (Legal Business Name): KOEN KERI ARION BAUM LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KERI KOEN ARION BAUM LMFT

II. Dates (important events)

Enumeration Date: 08/17/2010
Last Update Date: 08/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3896 24TH ST
SAN FRANCISCO CA
94114
US

IV. Provider business mailing address

3896 24TH ST
SAN FRANCISCO CA
94114
US

V. Phone/Fax

Practice location:
  • Phone: 415-646-0565
  • Fax:
Mailing address:
  • Phone: 415-646-0565
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code102L00000X
TaxonomyPsychoanalyst
License NumberLMFT#38312
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: