Provider Demographics
NPI:1407026883
Name:BALDWIN, CHARLES ERIC (LSW)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:ERIC
Last Name:BALDWIN
Suffix:
Gender:M
Credentials:LSW
Other - Prefix:MR
Other - First Name:CHARLES
Other - Middle Name:ERIC
Other - Last Name:BALDWIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS
Mailing Address - Street 1:3445 S MAIN ST
Mailing Address - Street 2:NA
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44319-3028
Mailing Address - Country:US
Mailing Address - Phone:330-245-1041
Mailing Address - Fax:330-245-1149
Practice Address - Street 1:3445 S MAIN ST
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44319-3028
Practice Address - Country:US
Practice Address - Phone:330-245-1041
Practice Address - Fax:330-245-1149
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-03
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS0021768101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health