Provider Demographics
NPI:1124891072
Name:BAUMSTARK, KYRA MAE (LCSW)
Entity type:Individual
Prefix:
First Name:KYRA
Middle Name:MAE
Last Name:BAUMSTARK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 RED SCHOOL LN APT J10
Mailing Address - Street 2:
Mailing Address - City:PHILLIPSBURG
Mailing Address - State:NJ
Mailing Address - Zip Code:08865-2245
Mailing Address - Country:US
Mailing Address - Phone:908-442-5709
Mailing Address - Fax:
Practice Address - Street 1:191 WOODPORT RD STE 206
Practice Address - Street 2:
Practice Address - City:SPARTA
Practice Address - State:NJ
Practice Address - Zip Code:07871-2641
Practice Address - Country:US
Practice Address - Phone:973-691-3030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-02
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC062415001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical