Provider Demographics
NPI:1659395457
Name:BALDINO, LOUIS (MA)
Entity Type:Individual
Prefix:MR
First Name:LOUIS
Middle Name:
Last Name:BALDINO
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HARLEYSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19438-2260
Mailing Address - Country:US
Mailing Address - Phone:215-256-6177
Mailing Address - Fax:215-256-6177
Practice Address - Street 1:500 MAIN ST
Practice Address - Street 2:
Practice Address - City:HARLEYSVILLE
Practice Address - State:PA
Practice Address - Zip Code:19438-2260
Practice Address - Country:US
Practice Address - Phone:215-256-6177
Practice Address - Fax:215-256-6177
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS-006941-L103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1484778Medicaid
PA1484778Medicaid
PA2344396000Medicare UPIN
PA03176901Medicare UPIN