Provider Demographics
NPI:1902108244
Name:BAUMSTARK, BETTY (MS)
Entity Type:Individual
Prefix:
First Name:BETTY
Middle Name:
Last Name:BAUMSTARK
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20162 CORTEZ BLVD
Mailing Address - Street 2:
Mailing Address - City:BROOKSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:34601-3832
Mailing Address - Country:US
Mailing Address - Phone:352-544-2300
Mailing Address - Fax:352-544-2303
Practice Address - Street 1:20162 CORTEZ BLVD
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34601-3832
Practice Address - Country:US
Practice Address - Phone:352-544-2300
Practice Address - Fax:352-544-2303
Is Sole Proprietor?:No
Enumeration Date:2010-11-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health