Provider Demographics
NPI:1639443831
Name:BAUM, EMILY (PHD)
Entity Type:Individual
Prefix:DR
First Name:EMILY
Middle Name:
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 1:2 VILLAGE SQ
Mailing Address - Street 2:SUITE 259
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21210-1612
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2 VILLAGE SQ
Practice Address - Street 2:SUITE 259
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21210-1612
Practice Address - Country:US
Practice Address - Phone:443-691-6766
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-06
Last Update Date:2012-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD04909103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist