Provider Demographics
NPI:1417590977
Name:KIM CHAN-BAERMAN LCSW LLC
Entity Type:Organization
Organization Name:KIM CHAN-BAERMAN LCSW LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAN-BAERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:609-800-2024
Mailing Address - Street 1:309 S NEW YORK RD STE 12
Mailing Address - Street 2:
Mailing Address - City:GALLOWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08205-6024
Mailing Address - Country:US
Mailing Address - Phone:609-992-8293
Mailing Address - Fax:609-382-7777
Practice Address - Street 1:309 S NEW YORK RD STE 12
Practice Address - Street 2:
Practice Address - City:GALLOWAY
Practice Address - State:NJ
Practice Address - Zip Code:08205-6024
Practice Address - Country:US
Practice Address - Phone:609-992-8293
Practice Address - Fax:609-382-7777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-28
Last Update Date:2019-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty