Healthcare Provider Details

I. General information

NPI: 1538088976
Provider Name (Legal Business Name): STACY BAUM LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2026
Last Update Date: 07/12/2026
Certification Date: 07/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1625 PUTNAM AVE APT 2J
RIDGEWOOD NY
11385-3455
US

IV. Provider business mailing address

1625 PUTNAM AVE APT 2J
RIDGEWOOD NY
11385-3455
US

V. Phone/Fax

Practice location:
  • Phone: 315-804-3477
  • Fax:
Mailing address:
  • Phone: 646-701-5977
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number018157
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: