Provider Demographics
NPI:1407133267
Name:BALDWIN, DONNELL JR
Entity Type:Individual
Prefix:MR
First Name:DONNELL
Middle Name:
Last Name:BALDWIN
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5420 GREENLEY GARDENS ST
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89081-4071
Mailing Address - Country:US
Mailing Address - Phone:702-797-0546
Mailing Address - Fax:
Practice Address - Street 1:5420 GREENLEY GARDENS ST
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89081-4071
Practice Address - Country:US
Practice Address - Phone:702-797-0546
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-08
Last Update Date:2011-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst