Healthcare Provider Details

I. General information

NPI: 1841370657
Provider Name (Legal Business Name): KATHERINE JEAN BAUM PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 12/02/2024
Certification Date: 12/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 FUNDY RD
FALMOUTH ME
04105-1774
US

IV. Provider business mailing address

5 FUNDY RD
FALMOUTH ME
04105-1774
US

V. Phone/Fax

Practice location:
  • Phone: 207-808-8059
  • Fax: 207-808-8069
Mailing address:
  • Phone: 207-808-8059
  • Fax: 207-808-8069

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPS2547
License Number StateME
# 2
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPY6303
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: