Provider Demographics
NPI:1689046732
Name:DINA BALDWIN BERDY LLC
Entity Type:Organization
Organization Name:DINA BALDWIN BERDY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOCIAL WORKER
Authorized Official - Prefix:MS
Authorized Official - First Name:DINA
Authorized Official - Middle Name:BALDWIN
Authorized Official - Last Name:BERDY
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:248-561-6875
Mailing Address - Street 1:575 E BIG BEAVER RD
Mailing Address - Street 2:SUITE 260
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-1300
Mailing Address - Country:US
Mailing Address - Phone:248-561-6875
Mailing Address - Fax:
Practice Address - Street 1:575 E BIG BEAVER RD
Practice Address - Street 2:SUITE 260
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48083-1300
Practice Address - Country:US
Practice Address - Phone:248-561-6875
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-28
Last Update Date:2015-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010843781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty