Provider Demographics
NPI:1003348087
Name:BALDAUF, ANNEMARIE (PSYD)
Entity type:Individual
Prefix:
First Name:ANNEMARIE
Middle Name:
Last Name:BALDAUF
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1208 MASSACHUSETTS AVE STE 7
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02138-3828
Mailing Address - Country:US
Mailing Address - Phone:617-958-8387
Mailing Address - Fax:617-830-7237
Practice Address - Street 1:1208 MASSACHUSETTS AVE STE 7
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-3828
Practice Address - Country:US
Practice Address - Phone:617-958-8387
Practice Address - Fax:617-830-7237
Is Sole Proprietor?:No
Enumeration Date:2017-03-29
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA11172103TC0700X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program