Provider Demographics
NPI:1639750847
Name:BALDWIN-BROWN, MALIEK
Entity Type:Individual
Prefix:
First Name:MALIEK
Middle Name:
Last Name:BALDWIN-BROWN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8117 ELK RIVER VW
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN
Mailing Address - State:CO
Mailing Address - Zip Code:80817-1573
Mailing Address - Country:US
Mailing Address - Phone:678-628-4826
Mailing Address - Fax:
Practice Address - Street 1:8117 ELK RIVER VIEW
Practice Address - Street 2:
Practice Address - City:FOUNTAIN
Practice Address - State:CO
Practice Address - Zip Code:80817
Practice Address - Country:US
Practice Address - Phone:678-628-4826
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-19
Last Update Date:2021-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician