Provider Demographics
NPI:1568231660
Name:CREASEY-BALDWIN, MARIA (CSW)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:CREASEY-BALDWIN
Suffix:
Gender:F
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:275 E SOUTH TEMPLE STE 103
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84111-1323
Mailing Address - Country:US
Mailing Address - Phone:385-218-8266
Mailing Address - Fax:
Practice Address - Street 1:275 E SOUTH TEMPLE
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84111-1247
Practice Address - Country:US
Practice Address - Phone:385-246-3392
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-29
Last Update Date:2023-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12333117-35021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical