Healthcare Provider Details

I. General information

NPI: 1750413647
Provider Name (Legal Business Name): SUSAN W BAUR LICPSY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

82 COUNTY ROAD
NORTH FALMOUTH MA
02556
US

IV. Provider business mailing address

PO BOX 1620
NORTH FALMOUTH MA
02556-1620
US

V. Phone/Fax

Practice location:
  • Phone: 508-564-5727
  • Fax:
Mailing address:
  • Phone: 508-945-2633
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number6274
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: