Provider Demographics
NPI:1942555214
Name:BAUMBACH, LISA ANNE MARIE (MSW, LMSW, LCSW)
Entity Type:Individual
Prefix:MS
First Name:LISA ANNE
Middle Name:MARIE
Last Name:BAUMBACH
Suffix:
Gender:F
Credentials:MSW, LMSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:71 KNOLLWOOD DR
Mailing Address - Street 2:
Mailing Address - City:VALATIE
Mailing Address - State:NY
Mailing Address - Zip Code:12184-5202
Mailing Address - Country:US
Mailing Address - Phone:518-755-4801
Mailing Address - Fax:
Practice Address - Street 1:71 KNOLLWOOD DR
Practice Address - Street 2:
Practice Address - City:VALATIE
Practice Address - State:NY
Practice Address - Zip Code:12184-5202
Practice Address - Country:US
Practice Address - Phone:518-755-4801
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-23
Last Update Date:2012-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA218126104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker