Healthcare Provider Details

I. General information

NPI: 1952450173
Provider Name (Legal Business Name): SAMUEL BAUMAN PHD, LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 10/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 GRAFTON LANE
BERRYVILLE VA
22611-0112
US

IV. Provider business mailing address

6107 BLUE WHALE CT
WALDORF MD
20603-4307
US

V. Phone/Fax

Practice location:
  • Phone: 540-955-5205
  • Fax:
Mailing address:
  • Phone: 301-843-7410
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701003704
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLC363
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: