Provider Demographics
NPI:1154495711
Name:BAUER, DEBORAH L (LCSW)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:L
Last Name:BAUER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 S 19TH ST
Mailing Address - Street 2:
Mailing Address - City:CAMP HILL
Mailing Address - State:PA
Mailing Address - Zip Code:17011-5459
Mailing Address - Country:US
Mailing Address - Phone:717-775-3380
Mailing Address - Fax:717-775-3382
Practice Address - Street 1:17 S 19TH ST
Practice Address - Street 2:
Practice Address - City:CAMP HILL
Practice Address - State:PA
Practice Address - Zip Code:17011-5459
Practice Address - Country:US
Practice Address - Phone:717-775-3380
Practice Address - Fax:717-775-3382
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2019-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0143121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001884930Medicaid
PA001884930Medicaid