Provider Demographics
NPI:1447403241
Name:BALDUS, CARMEN (EDD)
Entity Type:Individual
Prefix:DR
First Name:CARMEN
Middle Name:
Last Name:BALDUS
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7760 S RIVER RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:NEWAYGO
Mailing Address - State:MI
Mailing Address - Zip Code:49337-9673
Mailing Address - Country:US
Mailing Address - Phone:231-373-7969
Mailing Address - Fax:231-652-7200
Practice Address - Street 1:7769 S RIVER RIDGE RD
Practice Address - Street 2:
Practice Address - City:NEWAYGO
Practice Address - State:MI
Practice Address - Zip Code:49337-9673
Practice Address - Country:US
Practice Address - Phone:231-652-7200
Practice Address - Fax:231-652-7201
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-24
Last Update Date:2019-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301011963103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist