Provider Demographics
NPI:1275685331
Name:BAUMER, SALLY F (LCSW)
Entity Type:Individual
Prefix:
First Name:SALLY
Middle Name:F
Last Name:BAUMER
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 1:154 COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457-3201
Mailing Address - Country:US
Mailing Address - Phone:860-347-1415
Mailing Address - Fax:860-347-1415
Practice Address - Street 1:154 COLLEGE ST
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:CT
Practice Address - Zip Code:06457-3201
Practice Address - Country:US
Practice Address - Phone:860-347-1415
Practice Address - Fax:860-347-1415
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0043031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical