Provider Demographics
NPI:1285644609
Name:BALDWIN, SUZANNE M (PHD, LCSW)
Entity Type:Individual
Prefix:DR
First Name:SUZANNE
Middle Name:M
Last Name:BALDWIN
Suffix:
Gender:F
Credentials:PHD, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1492 S INDEPENDENCE BLVD
Mailing Address - Street 2:STE 104
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-5252
Mailing Address - Country:US
Mailing Address - Phone:757-466-3336
Mailing Address - Fax:757-455-5750
Practice Address - Street 1:1492 S INDEPENDENCE BLVD
Practice Address - Street 2:STE 104
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-5252
Practice Address - Country:US
Practice Address - Phone:757-466-3336
Practice Address - Fax:757-455-5750
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2021-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA9040038801041C0700X
VA09040038801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA8924724Medicaid
VAC05118Medicare UPIN
VA8924724Medicaid
VA800002529Medicare ID - Type Unspecified