Provider Demographics
NPI:1437130994
Name:BALDWIN, JOHN DAVID (LISW)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:DAVID
Last Name:BALDWIN
Suffix:
Gender:M
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21ST ST.
Mailing Address - Street 2:BLDG 2437
Mailing Address - City:FT. CAMPBELL
Mailing Address - State:KY
Mailing Address - Zip Code:42223
Mailing Address - Country:US
Mailing Address - Phone:270-798-8967
Mailing Address - Fax:270-956-0219
Practice Address - Street 1:21ST ST.
Practice Address - Street 2:BLDG 2437
Practice Address - City:FT. CAMPBELL
Practice Address - State:KY
Practice Address - Zip Code:42223
Practice Address - Country:US
Practice Address - Phone:270-798-8967
Practice Address - Fax:270-956-0219
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2018-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMM06007104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM69029814Medicaid