Provider Demographics
NPI:1083157465
Name:BAUM, DAVID ERIC (PSYD, LICDC)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:ERIC
Last Name:BAUM
Suffix:
Gender:M
Credentials:PSYD, LICDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9403 KENWOOD RD STE C111
Mailing Address - Street 2:
Mailing Address - City:BLUE ASH
Mailing Address - State:OH
Mailing Address - Zip Code:45242-6857
Mailing Address - Country:US
Mailing Address - Phone:513-792-1272
Mailing Address - Fax:513-891-4449
Practice Address - Street 1:9403 KENWOOD RD STE C111
Practice Address - Street 2:
Practice Address - City:BLUE ASH
Practice Address - State:OH
Practice Address - Zip Code:45242
Practice Address - Country:US
Practice Address - Phone:513-792-1272
Practice Address - Fax:513-891-4449
Is Sole Proprietor?:No
Enumeration Date:2016-12-02
Last Update Date:2018-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH161351101YA0400X
OH07686103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)