Healthcare Provider Details

I. General information

NPI: 1619256443
Provider Name (Legal Business Name): BETH MICHELLE BAUMEISTER PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2011
Last Update Date: 10/29/2021
Certification Date: 10/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2239 TOWNSGATE RD SUITE 107
WESTLAKE VILLAGE CA
91361-2405
US

IV. Provider business mailing address

545 ISLAND RD
RAMSEY NJ
07446-2813
US

V. Phone/Fax

Practice location:
  • Phone: 626-221-6187
  • Fax:
Mailing address:
  • Phone: 626-221-6187
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number20565
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number20565
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: