Provider Demographics
NPI:1679003800
Name:BALDIZON, MARLENE A (PH D)
Entity Type:Individual
Prefix:DR
First Name:MARLENE
Middle Name:A
Last Name:BALDIZON
Suffix:
Gender:F
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:340 KNEELAND RD.
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06512
Mailing Address - Country:US
Mailing Address - Phone:203-506-5161
Mailing Address - Fax:
Practice Address - Street 1:28 CRESCENT STREET
Practice Address - Street 2:MIDDLESEX HOSPITAL
Practice Address - City:MIDDLETOWN
Practice Address - State:CT
Practice Address - Zip Code:06457
Practice Address - Country:US
Practice Address - Phone:860-358-3438
Practice Address - Fax:860-358-3403
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-20
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003196103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical