Provider Demographics
NPI:1144887498
Name:BAUER, JOSEPH RAYMOND (BA OF PSYCHOLOGY)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:RAYMOND
Last Name:BAUER
Suffix:
Gender:M
Credentials:BA OF PSYCHOLOGY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6360 TECHSTER BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33966-4805
Mailing Address - Country:US
Mailing Address - Phone:239-223-2751
Mailing Address - Fax:239-703-7883
Practice Address - Street 1:6360 TECHSTER BLVD
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33966-4805
Practice Address - Country:US
Practice Address - Phone:239-223-2751
Practice Address - Fax:239-703-7883
Is Sole Proprietor?:No
Enumeration Date:2019-05-22
Last Update Date:2019-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator