Provider Demographics
NPI:1952450173
Name:BAUMAN, SAMUEL (PHD, LPC)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:
Last Name:BAUMAN
Suffix:
Gender:M
Credentials:PHD, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6107 BLUE WHALE CT
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20603-4307
Mailing Address - Country:US
Mailing Address - Phone:301-843-7410
Mailing Address - Fax:
Practice Address - Street 1:180 GRAFTON LANE
Practice Address - Street 2:
Practice Address - City:BERRYVILLE
Practice Address - State:VA
Practice Address - Zip Code:22611-0112
Practice Address - Country:US
Practice Address - Phone:540-955-5205
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701003704101YP2500X
MDLC363101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional