Provider Demographics
NPI:1215011143
Name:BAUMSTARK, KAREN E (PHD)
Entity Type:Individual
Prefix:DR
First Name:KAREN
Middle Name:E
Last Name:BAUMSTARK
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14821 MARTHA CIR
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68144-2038
Mailing Address - Country:US
Mailing Address - Phone:402-330-0668
Mailing Address - Fax:
Practice Address - Street 1:11905 ARBOR ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68144-2970
Practice Address - Country:US
Practice Address - Phone:402-330-8850
Practice Address - Fax:402-330-8873
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE287103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
08380OtherBCBS PROVIDER #
143189300OtherDOL OWCP
IA0554147Medicaid
NE47076043402Medicaid
346048000OtherMAGELLAN PROVIDER MIS #
143189300OtherDOL OWCP