Provider Demographics
NPI:1871716449
Name:BAUMGART, ELAYNE P (PH D)
Entity type:Individual
Prefix:
First Name:ELAYNE
Middle Name:P
Last Name:BAUMGART
Suffix:
Gender:F
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 35216
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44735-5216
Mailing Address - Country:US
Mailing Address - Phone:216-591-1664
Mailing Address - Fax:
Practice Address - Street 1:3937 W MEADOW LN
Practice Address - Street 2:
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-4720
Practice Address - Country:US
Practice Address - Phone:216-591-1664
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2008-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3229103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical