Provider Demographics
NPI:1497232441
Name:BALDWIN, JEFFREY THERON (MSW)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:THERON
Last Name:BALDWIN
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57 JACKSON CIR
Mailing Address - Street 2:
Mailing Address - City:MARLBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01752-5603
Mailing Address - Country:US
Mailing Address - Phone:508-251-2469
Mailing Address - Fax:
Practice Address - Street 1:57 JACKSON CIR
Practice Address - Street 2:
Practice Address - City:MARLBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01752-5603
Practice Address - Country:US
Practice Address - Phone:508-251-2469
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-23
Last Update Date:2018-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10265121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical