Provider Demographics
NPI:1750829172
Name:BALDOVIN, STEFANIE
Entity Type:Individual
Prefix:MS
First Name:STEFANIE
Middle Name:
Last Name:BALDOVIN
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 1:466 ASHWORTH AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-4901
Mailing Address - Country:US
Mailing Address - Phone:917-991-2133
Mailing Address - Fax:
Practice Address - Street 1:466 ASHWORTH AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-4901
Practice Address - Country:US
Practice Address - Phone:917-991-2133
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-06
Last Update Date:2017-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst