Provider Demographics
NPI:1487796538
Name:BAUMGARTEN, GRACE A (LCSW)
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:A
Last Name:BAUMGARTEN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:218 LORRAINE AVE
Mailing Address - Street 2:
Mailing Address - City:UPPER MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07043-1915
Mailing Address - Country:US
Mailing Address - Phone:973-746-7731
Mailing Address - Fax:973-746-0156
Practice Address - Street 1:218 LORRAINE AVE
Practice Address - Street 2:
Practice Address - City:UPPER MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07043-1915
Practice Address - Country:US
Practice Address - Phone:973-746-7731
Practice Address - Fax:973-746-0156
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJSC030721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ645452Medicare ID - Type Unspecified