Healthcare Provider Details

I. General information

NPI: 1073233003
Provider Name (Legal Business Name): ALEXANDER GEORGE BAUMAN LCSW, CADC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2022
Last Update Date: 10/25/2025
Certification Date: 10/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3534 CLARENCE AVE
BERWYN IL
60402-3855
US

IV. Provider business mailing address

3534 CLARENCE AVE
BERWYN IL
60402-3855
US

V. Phone/Fax

Practice location:
  • Phone: 312-330-2561
  • Fax:
Mailing address:
  • Phone: 312-330-2561
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149.029227
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number149.029227
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number39359
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: