Provider Demographics
NPI:1659793941
Name:BALDWIN, BURKE THOMAS (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:BURKE
Middle Name:THOMAS
Last Name:BALDWIN
Suffix:
Gender:M
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:BURKE
Other - Middle Name:
Other - Last Name:HALINOVYCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW, LCSW
Mailing Address - Street 1:2 FIFER AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:CORTE MADERA
Mailing Address - State:CA
Mailing Address - Zip Code:94925-1174
Mailing Address - Country:US
Mailing Address - Phone:415-855-0198
Mailing Address - Fax:
Practice Address - Street 1:2 FIFER AVE STE 200
Practice Address - Street 2:
Practice Address - City:CORTE MADERA
Practice Address - State:CA
Practice Address - Zip Code:94925-1174
Practice Address - Country:US
Practice Address - Phone:415-855-0198
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-06
Last Update Date:2023-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL32434101YA0400X
IL149.0172211041C0700X
CA862491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)