Provider Demographics
NPI:1912309253
Name:BAUER, PRISCILLA S (LCSW)
Entity Type:Individual
Prefix:MS
First Name:PRISCILLA
Middle Name:S
Last Name:BAUER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1 AVALON WAY UNIT 1171
Mailing Address - Street 2:
Mailing Address - City:BOONTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07005-2339
Mailing Address - Country:US
Mailing Address - Phone:848-391-2809
Mailing Address - Fax:973-588-3212
Practice Address - Street 1:830 MORRIS TPKE STE 405
Practice Address - Street 2:
Practice Address - City:SHORT HILLS
Practice Address - State:NJ
Practice Address - Zip Code:07078-2625
Practice Address - Country:US
Practice Address - Phone:848-391-2809
Practice Address - Fax:973-588-3212
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-18
Last Update Date:2020-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC055839001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical