Provider Demographics
NPI:1457850190
Name:MOSS-BALDWIN, DEBRA (LLMSW)
Entity Type:Individual
Prefix:MISS
First Name:DEBRA
Middle Name:
Last Name:MOSS-BALDWIN
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:MISS
Other - First Name:DEBRA
Other - Middle Name:
Other - Last Name:BALDWIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LLMSW
Mailing Address - Street 1:4250 WOODWARD AVE
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48201-1818
Mailing Address - Country:US
Mailing Address - Phone:313-833-8100
Mailing Address - Fax:313-833-3393
Practice Address - Street 1:4250 WOODWARD AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-1818
Practice Address - Country:US
Practice Address - Phone:313-833-8100
Practice Address - Fax:313-833-3393
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-08
Last Update Date:2018-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011013361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical