Provider Demographics
NPI:1831642032
Name:BALDWIN, ANGELA (MA, RMHCI)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:BALDWIN
Suffix:
Gender:F
Credentials:MA, RMHCI
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:
Other - Last Name:PORCELLINI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, RMHCI
Mailing Address - Street 1:814 LEWIS PL
Mailing Address - Street 2:
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32750-3792
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:841 JIMMY ANN DR
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32117-4583
Practice Address - Country:US
Practice Address - Phone:386-425-3900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-25
Last Update Date:2019-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
FLIMH16383101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1831642032Medicaid