Provider Demographics
NPI:1023554920
Name:BAUER, TALYA (LPC, ACS)
Entity Type:Individual
Prefix:
First Name:TALYA
Middle Name:
Last Name:BAUER
Suffix:
Gender:F
Credentials:LPC, ACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 MIDDLETOWN AVE
Mailing Address - Street 2:
Mailing Address - City:ATLANTIC HIGHLANDS
Mailing Address - State:NJ
Mailing Address - Zip Code:07716-2103
Mailing Address - Country:US
Mailing Address - Phone:732-314-3188
Mailing Address - Fax:
Practice Address - Street 1:10 MIDDLETOWN AVE
Practice Address - Street 2:
Practice Address - City:ATLANTIC HIGHLANDS
Practice Address - State:NJ
Practice Address - Zip Code:07716-2103
Practice Address - Country:US
Practice Address - Phone:732-314-3188
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-16
Last Update Date:2022-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00611800101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor