Provider Demographics
NPI:1457924839
Name:BAUMBUSCH MARRIAGE AND FAMILY THERAPY PLLC
Entity Type:Organization
Organization Name:BAUMBUSCH MARRIAGE AND FAMILY THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/LMFT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:BAUMBUSCH
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:973-771-6909
Mailing Address - Street 1:1080 BERGEN ST # 169
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11216-3340
Mailing Address - Country:US
Mailing Address - Phone:973-771-6909
Mailing Address - Fax:
Practice Address - Street 1:90 BROAD ST. STE 1013
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10004
Practice Address - Country:US
Practice Address - Phone:973-771-6909
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-22
Last Update Date:2021-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty