Healthcare Provider Details

I. General information

NPI: 1255433421
Provider Name (Legal Business Name): STEVEN KEITH BAUM PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: STEVEN K BAUM PHD

II. Dates (important events)

Enumeration Date: 09/01/2006
Last Update Date: 12/08/2019
Certification Date: 12/08/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3620 WYOMING BLVD NE STE 112
ALBUQUERQUE NM
87111-3288
US

IV. Provider business mailing address

3620 WYOMING BLVD NE STE 112
ALBUQUERQUE NM
87111-3288
US

V. Phone/Fax

Practice location:
  • Phone: 505-918-2750
  • Fax: 505-214-5897
Mailing address:
  • Phone: 505-918-2750
  • Fax: 505-508-5438

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberMI 5686
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number0949NEWMEXICO
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: