Healthcare Provider Details

I. General information

NPI: 1427788793
Provider Name (Legal Business Name): JONAH BAUMHAFT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2022
Last Update Date: 06/10/2022
Certification Date: 06/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

74 W ECKERSON RD
SPRING VALLEY NY
10977-3610
US

IV. Provider business mailing address

PO BOX 525
MONSEY NY
10952-0525
US

V. Phone/Fax

Practice location:
  • Phone: 845-213-9972
  • Fax:
Mailing address:
  • Phone: 845-352-6454
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number012387
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: