Provider Demographics
NPI:1235868225
Name:BALDWIN, JENNA N (LGPC, CACAD)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:N
Last Name:BALDWIN
Suffix:
Gender:F
Credentials:LGPC, CACAD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1186 ANNIS SQUAM HARBOUR
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:MD
Mailing Address - Zip Code:21122-2554
Mailing Address - Country:US
Mailing Address - Phone:410-474-8353
Mailing Address - Fax:
Practice Address - Street 1:1186 ANNIS SQUAM HARBOUR
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:MD
Practice Address - Zip Code:21122-2554
Practice Address - Country:US
Practice Address - Phone:410-474-8353
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-07
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDAC2929101YA0400X
MDLGP12895101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)