Provider Demographics
NPI:1669539722
Name:BAUME, DEREK JAY (PSYD)
Entity type:Individual
Prefix:DR
First Name:DEREK
Middle Name:JAY
Last Name:BAUME
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12337 HANCOCK ST 20
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-5885
Mailing Address - Country:US
Mailing Address - Phone:317-706-6744
Mailing Address - Fax:317-706-6700
Practice Address - Street 1:12337 HANCOCK ST 20
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-5885
Practice Address - Country:US
Practice Address - Phone:317-706-6744
Practice Address - Fax:317-706-6700
Is Sole Proprietor?:No
Enumeration Date:2007-01-01
Last Update Date:2015-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20042084A103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ININ1231OtherMEDICARE GROUP
IN201178980AMedicaid
ININ1231001OtherMEDICARE PTAN
IN201163980Medicaid