Provider Demographics
NPI:1417585928
Name:GLAZER BALDWIN, KELLY ERIN (LCSW)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:ERIN
Last Name:GLAZER BALDWIN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1024 HARVARD RD
Mailing Address - Street 2:
Mailing Address - City:PIEDMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94610-1162
Mailing Address - Country:US
Mailing Address - Phone:415-310-2550
Mailing Address - Fax:
Practice Address - Street 1:400 29TH ST STE 514
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-3550
Practice Address - Country:US
Practice Address - Phone:415-310-2550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-30
Last Update Date:2020-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA280971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty