Provider Demographics
NPI:1578725784
Name:BAUMWOLL, RICHARD (PHD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:
Last Name:BAUMWOLL
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 MOUNTAIN AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:WESTFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07090-3152
Mailing Address - Country:US
Mailing Address - Phone:908-233-7801
Mailing Address - Fax:908-889-4906
Practice Address - Street 1:202 MOUNTAIN AVE
Practice Address - Street 2:SUITE A
Practice Address - City:WESTFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07090-3152
Practice Address - Country:US
Practice Address - Phone:908-233-7801
Practice Address - Fax:908-889-4906
Is Sole Proprietor?:No
Enumeration Date:2008-06-29
Last Update Date:2008-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00231600103T00000X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103T00000XBehavioral Health & Social Service ProvidersPsychologist