Healthcare Provider Details

I. General information

NPI: 1770191033
Provider Name (Legal Business Name): ROSEMARY LAUREL BAUMAN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2020
Last Update Date: 07/22/2020
Certification Date: 07/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 LOS JARDINES PL NW
ALBUQUERQUE NM
87104-2317
US

IV. Provider business mailing address

1515 LOS JARDINES PL NW
ALBUQUERQUE NM
87104-2317
US

V. Phone/Fax

Practice location:
  • Phone: 505-385-0443
  • Fax:
Mailing address:
  • Phone: 505-385-0443
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC-3555
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: