Provider Demographics
NPI:1144377557
Name:BALDWIN, DUSTIN JAY LAWRENCE (MSW, LCSW)
Entity Type:Individual
Prefix:MR
First Name:DUSTIN
Middle Name:JAY LAWRENCE
Last Name:BALDWIN
Suffix:
Gender:M
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:2051 KAEN RD
Mailing Address - Street 2:SUITE 367
Mailing Address - City:OREGON CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97045-4035
Mailing Address - Country:US
Mailing Address - Phone:503-742-5300
Mailing Address - Fax:503-742-5979
Practice Address - Street 1:38872 PROCTOR BLVD
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:OR
Practice Address - Zip Code:97055-8035
Practice Address - Country:US
Practice Address - Phone:503-722-6950
Practice Address - Fax:503-722-6939
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL51401041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical