Individual provider Active NPI

Marla Rachel Baum, PSY.D.

  • Clinical Child & Adolescent Psychologist
  • New York, NY
National Provider Identifier
1376741512
Registry record updated Jul 10, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Child & Adolescent PsychologistTaxonomy code 103TC2200X
License
015586 Issued in NY
Practice address
350 Central Park W
Suite 1-Q
New York, NY 10025-6547
Phone
(917) 331-4809
Fax
(212) 666-3185
NPI assigned
Jul 10, 2007
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 10, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Neuropsychologist 103G00000X 015586 NY
Clinical Child & Adolescent Psychologist 103TC2200X 015586 NY Primary
Intellectual & Developmental Disabilities Psychologist 103TM1800X 015586 NY

Addresses

Primary practice location

350 Central Park W
Suite 1-Q
New York, NY 10025-6547

Mailing address

350 Central Park W
Suite 1-Q
New York, NY 10025-6547
Phone (917) 331-4809

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
015586NYMDClinical Child & Adolescent Psychologist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1184025600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1184025600000",
    "number": "1376741512",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "350 CENTRAL PARK W",
            "address_2": "SUITE 1-Q",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100256547",
            "telephone_number": "917-331-4809",
            "fax_number": "212-666-3185"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "350 CENTRAL PARK W",
            "address_2": "SUITE 1-Q",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100256547",
            "telephone_number": "917-331-4809",
            "fax_number": "212-666-3185"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BAUM",
        "first_name": "MARLA",
        "middle_name": "RACHEL",
        "name_prefix": "Dr.",
        "credential": "PSY.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-07-10",
        "last_updated": "2007-07-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "",
            "desc": "Clinical Neuropsychologist",
            "state": "NY",
            "license": "015586",
            "primary": false
        },
        {
            "code": "103TC2200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": "NY",
            "license": "015586",
            "primary": true
        },
        {
            "code": "103TM1800X",
            "taxonomy_group": "",
            "desc": "Psychologist, Intellectual & Developmental Disabilities",
            "state": "NY",
            "license": "015586",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.