Provider Demographics
NPI:1407922289
Name:BAUM, DANIELLE VAUGHN (PHD)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:VAUGHN
Last Name:BAUM
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 1:8066 N 56TH ST
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33617-7620
Mailing Address - Country:US
Mailing Address - Phone:813-983-9350
Mailing Address - Fax:813-985-7149
Practice Address - Street 1:8066 N 56TH ST
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33617-7620
Practice Address - Country:US
Practice Address - Phone:813-983-9350
Practice Address - Fax:813-985-7149
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY3717103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL73476Medicare ID - Type UnspecifiedMEDICARE