Provider Demographics
NPI:1053684126
Name:BAUM, WENDY GABEL (LCSW-R)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:GABEL
Last Name:BAUM
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1240 DELAWARE AVE
Mailing Address - Street 2:APT 412
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14209-1455
Mailing Address - Country:US
Mailing Address - Phone:716-603-3866
Mailing Address - Fax:
Practice Address - Street 1:1240 DELAWARE AVE
Practice Address - Street 2:APT 412
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14209-1455
Practice Address - Country:US
Practice Address - Phone:716-603-3866
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-20
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYLCSW-R#0708201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical