Provider Demographics
NPI:1710290879
Name:BAUMANN, LAURIE MICHELLE (TSHH, MS, BCBA, SDL)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:MICHELLE
Last Name:BAUMANN
Suffix:
Gender:F
Credentials:TSHH, MS, BCBA, SDL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 BRIAN ST
Mailing Address - Street 2:
Mailing Address - City:PLAINVIEW
Mailing Address - State:NY
Mailing Address - Zip Code:11803-2101
Mailing Address - Country:US
Mailing Address - Phone:631-926-9144
Mailing Address - Fax:
Practice Address - Street 1:125 E BETHPAGE RD
Practice Address - Street 2:SUITE 5
Practice Address - City:PLAINVIEW
Practice Address - State:NY
Practice Address - Zip Code:11803-4228
Practice Address - Country:US
Practice Address - Phone:516-731-5588
Practice Address - Fax:516-577-9617
Is Sole Proprietor?:No
Enumeration Date:2010-07-19
Last Update Date:2012-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No174400000XOther Service ProvidersSpecialist