Provider Demographics
NPI:1811366206
Name:BAUMAN-RENNA, RANDIE (LMSW)
Entity type:Individual
Prefix:MRS
First Name:RANDIE
Middle Name:
Last Name:BAUMAN-RENNA
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 FRANKLIN PL
Mailing Address - Street 2:
Mailing Address - City:WOODMERE
Mailing Address - State:NY
Mailing Address - Zip Code:11598-1217
Mailing Address - Country:US
Mailing Address - Phone:516-374-3671
Mailing Address - Fax:516-374-7864
Practice Address - Street 1:112 FRANKLIN PL
Practice Address - Street 2:
Practice Address - City:WOODMERE
Practice Address - State:NY
Practice Address - Zip Code:11598-1217
Practice Address - Country:US
Practice Address - Phone:516-374-3671
Practice Address - Fax:516-374-7864
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-16
Last Update Date:2020-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY083139101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01880051Medicaid