Provider Demographics
NPI:1114537131
Name:ANNEMARIE BALDAUF, PSYD, PLLC
Entity Type:Organization
Organization Name:ANNEMARIE BALDAUF, PSYD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANNEMARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BALDAUF
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:312-806-1884
Mailing Address - Street 1:22 LINCOLN ST UNIT 3
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02145-3460
Mailing Address - Country:US
Mailing Address - Phone:312-806-1884
Mailing Address - Fax:
Practice Address - Street 1:1208 MASSACHUSETTS AVE STE 7
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-3828
Practice Address - Country:US
Practice Address - Phone:617-958-8387
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-04
Last Update Date:2022-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty