Provider Demographics
NPI:1538644240
Name:BAIDEN, JONATHAN (LCSW-C, LICSW)
Entity Type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:
Last Name:BAIDEN
Suffix:
Gender:M
Credentials:LCSW-C, LICSW
Other - Prefix:MR
Other - First Name:JONATHAN
Other - Middle Name:
Other - Last Name:BAIDEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW-C, LICSW
Mailing Address - Street 1:12530 FAIRWOOD PKWY STE 102 #317
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20720-5756
Mailing Address - Country:US
Mailing Address - Phone:301-244-9126
Mailing Address - Fax:
Practice Address - Street 1:12530 FAIRWOOD PKWY STE 102 #317
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20720-5756
Practice Address - Country:US
Practice Address - Phone:301-244-9126
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-27
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC2000021161041C0700X
NCC0169271041C0700X
MD242431041C0700X
VA09040156561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty