Provider Demographics
NPI:1710057682
Name:CREED BAUMAN, DONNA MARIE (LICSW)
Entity Type:Individual
Prefix:MS
First Name:DONNA
Middle Name:MARIE
Last Name:CREED BAUMAN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 CHAPELGATE RD
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MA
Mailing Address - Zip Code:02021-2661
Mailing Address - Country:US
Mailing Address - Phone:781-828-4887
Mailing Address - Fax:
Practice Address - Street 1:275 TURNPIKE ST
Practice Address - Street 2:SUITE 105
Practice Address - City:CANTON
Practice Address - State:MA
Practice Address - Zip Code:02021-2357
Practice Address - Country:US
Practice Address - Phone:781-424-2950
Practice Address - Fax:781-821-1743
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1026252101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP08614OtherBLUE CROSS BLUE SHIELD OF
MA696145OtherTUFTS HEALTH PLAN
MAP08614OtherBLUE CARE ELECT
MAP08614OtherBLUE CARE ELECT