Basic Information
| Provider Information | |||||||||
| NPI: | 1841370657 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BAUM | ||||||||
| FirstName: | KATHERINE | ||||||||
| MiddleName: | JEAN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PH.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1881 N UNIVERSITY DR STE 104 | ||||||||
| Address2: | |||||||||
| City: | CORAL SPRINGS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330716093 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9543400888 | ||||||||
| FaxNumber: | 9543460909 | ||||||||
| Practice Location | |||||||||
| Address1: | 1881 N UNIVERSITY DR STE 104 | ||||||||
| Address2: | |||||||||
| City: | CORAL SPRINGS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330716093 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9543400888 | ||||||||
| FaxNumber: | 9543460909 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/16/2006 | ||||||||
| LastUpdateDate: | 04/08/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103G00000X | PY6303 | FL | Y | Behavioral Health & Social Service Providers | Clinical Neuropsychologist |
ID Information
| ID | Type | State | Issuer | Description | 1011377 | 05 | VT | MEDICAID |