Healthcare Provider Details

I. General information

NPI: 1396809794
Provider Name (Legal Business Name): FRED J. BAUMANN LMSW & MA.LLP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8062 ORTONVILLE RD
CLARKSTON MI
48348-4456
US

IV. Provider business mailing address

8062 ORTONVILLE RD
CLARKSTON MI
48348-4456
US

V. Phone/Fax

Practice location:
  • Phone: 248-625-2970
  • Fax: 248-625-6829
Mailing address:
  • Phone: 248-625-2970
  • Fax: 248-625-6829

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number6301006566
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801012294
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: