Provider Demographics
NPI:1710264510
Name:BAUMGARTNER, AMY KAROL (LMHC, NCC, CASAC)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:KAROL
Last Name:BAUMGARTNER
Suffix:
Gender:F
Credentials:LMHC, NCC, CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 OLD COUNTRY RD
Mailing Address - Street 2:
Mailing Address - City:DEER PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11729-1824
Mailing Address - Country:US
Mailing Address - Phone:516-712-8620
Mailing Address - Fax:
Practice Address - Street 1:74 FIRE ISLAND AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11702-3531
Practice Address - Country:US
Practice Address - Phone:516-712-8620
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-08
Last Update Date:2011-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY4088101YA0400X
NY101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)