Provider Demographics
NPI:1205981131
Name:BALDWIN, ELIZABETH ANNE (PSYD)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:ANNE
Last Name:BALDWIN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:120 POST ROAD WEST
Mailing Address - Street 2:SUITE 102C
Mailing Address - City:WESTPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06880
Mailing Address - Country:US
Mailing Address - Phone:203-247-1518
Mailing Address - Fax:203-227-1121
Practice Address - Street 1:120 POST ROAD WEST
Practice Address - Street 2:SUITE 102C
Practice Address - City:WESTPORT
Practice Address - State:CT
Practice Address - Zip Code:06880
Practice Address - Country:US
Practice Address - Phone:203-247-1518
Practice Address - Fax:203-227-1121
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2015-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002355103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical