Provider Demographics
NPI:1336451731
Name:KATHERINE J BAUM PC
Entity Type:Organization
Organization Name:KATHERINE J BAUM PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:PARE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:802-773-0250
Mailing Address - Street 1:242 WILLOW RD
Mailing Address - Street 2:
Mailing Address - City:BENNINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05201-8038
Mailing Address - Country:US
Mailing Address - Phone:802-442-3520
Mailing Address - Fax:802-447-3392
Practice Address - Street 1:160 BENMONT AVE
Practice Address - Street 2:SUITE 20
Practice Address - City:BENNINGTON
Practice Address - State:VT
Practice Address - Zip Code:05201-1873
Practice Address - Country:US
Practice Address - Phone:802-442-3520
Practice Address - Fax:802-447-3392
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-14
Last Update Date:2010-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0480000854103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
4144421OtherMVP