Provider Demographics
NPI:1780351445
Name:BAUER, DANIEL M (MFT MED)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:M
Last Name:BAUER
Suffix:
Gender:M
Credentials:MFT MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 BALA AVE STE 125
Mailing Address - Street 2:
Mailing Address - City:BALA CYNWYD
Mailing Address - State:PA
Mailing Address - Zip Code:19004-3217
Mailing Address - Country:US
Mailing Address - Phone:718-869-2788
Mailing Address - Fax:
Practice Address - Street 1:1 BALA AVE STE 125
Practice Address - Street 2:
Practice Address - City:BALA CYNWYD
Practice Address - State:PA
Practice Address - Zip Code:19004-3217
Practice Address - Country:US
Practice Address - Phone:718-869-2788
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-30
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist