Provider Demographics
NPI:1639384068
Name:BALDWIN, MARILYN EDITH (LMSW)
Entity Type:Individual
Prefix:
First Name:MARILYN
Middle Name:EDITH
Last Name:BALDWIN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:LYNN
Other - Middle Name:
Other - Last Name:BALDWIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMSW
Mailing Address - Street 1:102 W WASHINGTON ST
Mailing Address - Street 2:SUITE 114
Mailing Address - City:MARQUETTE
Mailing Address - State:MI
Mailing Address - Zip Code:49855-4368
Mailing Address - Country:US
Mailing Address - Phone:906-226-6059
Mailing Address - Fax:906-226-6059
Practice Address - Street 1:102 W WASHINGTON ST
Practice Address - Street 2:SUITE 114
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855-4368
Practice Address - Country:US
Practice Address - Phone:906-226-6059
Practice Address - Fax:906-226-6059
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010777071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P28690Medicare ID - Type Unspecified