Healthcare Provider Details

I. General information

NPI: 1164406948
Provider Name (Legal Business Name): BARBARA JOSEPHINE BAER MA LMFT LPC LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: X

Provider Other Name: MISS BARBARA JOSPHINE PETTAVINO

II. Dates (important events)

Enumeration Date: 12/05/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5300 S 108TH ST RECOVERY POINT SC SUITE 12B
HALES CORNERS WI
53130-1368
US

IV. Provider business mailing address

5300 S 108TH ST RECOVERY POINT SC SUITE 12B
HALES CORNERS WI
53130-1368
US

V. Phone/Fax

Practice location:
  • Phone: 414-529-2591
  • Fax: 414-529-2669
Mailing address:
  • Phone: 414-529-2591
  • Fax: 414-529-2669

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number165125
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1948123
License Number StateWI
# 3
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number6124
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: