Provider Demographics
NPI:1619198751
Name:BAUER, ALBERT WILLIAM (LCSW)
Entity Type:Individual
Prefix:
First Name:ALBERT
Middle Name:WILLIAM
Last Name:BAUER
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:426 MARIETTA ST NW
Mailing Address - Street 2:#206
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30313
Mailing Address - Country:US
Mailing Address - Phone:404-589-4695
Mailing Address - Fax:404-378-2394
Practice Address - Street 1:120 EAST TRINITY PLACE
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030
Practice Address - Country:US
Practice Address - Phone:404-378-2300
Practice Address - Fax:404-378-2394
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW000454104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker