Provider Demographics
NPI:1841370657
Name:BAUM, KATHERINE JEAN (PHD)
Entity type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:JEAN
Last Name:BAUM
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 FUNDY RD
Mailing Address - Street 2:
Mailing Address - City:FALMOUTH
Mailing Address - State:ME
Mailing Address - Zip Code:04105-1774
Mailing Address - Country:US
Mailing Address - Phone:207-808-8059
Mailing Address - Fax:207-808-8069
Practice Address - Street 1:5 FUNDY RD
Practice Address - Street 2:
Practice Address - City:FALMOUTH
Practice Address - State:ME
Practice Address - Zip Code:04105-1774
Practice Address - Country:US
Practice Address - Phone:207-808-8059
Practice Address - Fax:207-808-8069
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2024-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPS2547103G00000X
FLPY6303103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1011377Medicaid
VTVN3681Medicare PIN