Healthcare Provider Details

I. General information

NPI: 1720945454
Provider Name (Legal Business Name): KELLY M BAUMAN LCSW LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2026
Last Update Date: 01/06/2026
Certification Date: 01/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2073 SILVERWOOD LN
CHESTERFIELD MO
63017-7425
US

IV. Provider business mailing address

2073 SILVERWOOD LN
CHESTERFIELD MO
63017-7425
US

V. Phone/Fax

Practice location:
  • Phone: 516-729-7308
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: KELLY BAUMAN
Title or Position: LCSW
Credential:
Phone: 516-729-7308