Provider Demographics
NPI:1619256443
Name:BAUMEISTER, BETH MICHELLE (PHD)
Entity Type:Individual
Prefix:DR
First Name:BETH
Middle Name:MICHELLE
Last Name:BAUMEISTER
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 1:545 ISLAND RD
Mailing Address - Street 2:
Mailing Address - City:RAMSEY
Mailing Address - State:NJ
Mailing Address - Zip Code:07446-2813
Mailing Address - Country:US
Mailing Address - Phone:626-221-6187
Mailing Address - Fax:
Practice Address - Street 1:2239 TOWNSGATE RD
Practice Address - Street 2:SUITE 107
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91361-2405
Practice Address - Country:US
Practice Address - Phone:626-221-6187
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-10
Last Update Date:2021-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20565103G00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist