Provider Demographics
NPI: | 1013429877 |
---|---|
Name: | BAUMES, ANDREA (BCBA) |
Entity Type: | Individual |
Prefix: | |
First Name: | ANDREA |
Middle Name: | |
Last Name: | BAUMES |
Suffix: | |
Gender: | F |
Credentials: | BCBA |
Other - Prefix: | |
Other - First Name: | ANDREA |
Other - Middle Name: | |
Other - Last Name: | VERMESI |
Other - Suffix: | |
Other - Last Name Type: | Former Name |
Other - Credentials: | |
Mailing Address - Street 1: | 3040 AVEMORE SQUARE PL |
Mailing Address - Street 2: | |
Mailing Address - City: | CHARLOTTESVILLE |
Mailing Address - State: | VA |
Mailing Address - Zip Code: | 22911-7228 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 434-220-0089 |
Mailing Address - Fax: | 434-220-0103 |
Practice Address - Street 1: | 3040 AVEMORE SQUARE PL |
Practice Address - Street 2: | |
Practice Address - City: | CHARLOTTESVILLE |
Practice Address - State: | VA |
Practice Address - Zip Code: | 22911-7228 |
Practice Address - Country: | US |
Practice Address - Phone: | 434-220-0089 |
Practice Address - Fax: | 434-220-0103 |
Is Sole Proprietor?: | Yes |
Enumeration Date: | 2017-11-01 |
Last Update Date: | 2023-09-20 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
1-20-43268 | 103K00000X | |
VA | 0133003081 | 103K00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 103K00000X | Behavioral Health & Social Service Providers | Behavior Analyst |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
14920677 | Other | CAQH PROVIDER ID | |
1-20-43268 | Other | BEHAVIOR ANALYST CERTIFICATION BOARD | |
VA | 0133003081 | Other | LBA |