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General NPI Number Information
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NPI Number | 1609015635
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Entity Type | Individual
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Provider Name | MARIAN RUTH BAUMAN-O'DELL LMHC, CASAC
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Gender | Female
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Dates
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Enumeration Date | 02/15/2009
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Last Update Date | 02/15/2009
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Provider Practice Location Address
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Address Line | 1355 TITUS AVE
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City | ROCHESTER
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State | NY
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Zip | 14622-1731
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Country | US
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Telephone | 585-748-1209
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Fax |
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Provider Business Mailing Address
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Address Line | 560 BARRY RD
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City | ROCHESTER
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State | NY
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Zip | 14617-4742
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Country | US
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Telephone | 585-748-1209
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 4223
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 000846
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License Number State | NY
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