Provider Demographics
NPI:1396846689
Name:BALDWIN, PATRICK STEPHEN (LCSW)
Entity Type:Individual
Prefix:MR
First Name:PATRICK
Middle Name:STEPHEN
Last Name:BALDWIN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2709 OAKRIDGE ROAD
Mailing Address - Street 2:
Mailing Address - City:BURLESON
Mailing Address - State:TX
Mailing Address - Zip Code:76026-1955
Mailing Address - Country:US
Mailing Address - Phone:817-447-1074
Mailing Address - Fax:817-419-8670
Practice Address - Street 1:3100 MATLOCK ROAD,
Practice Address - Street 2:SUITE109
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76015-2900
Practice Address - Country:US
Practice Address - Phone:817-795-2704
Practice Address - Fax:817-419-8670
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX103281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00S40RMedicare ID - Type UnspecifiedPROVIDER NUMBER