Provider Demographics
NPI:1740928639
Name:BALDWIN, NIKKI LEE ROSE (LMHC)
Entity type:Individual
Prefix:MS
First Name:NIKKI
Middle Name:LEE ROSE
Last Name:BALDWIN
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 GENEVA ST
Mailing Address - Street 2:
Mailing Address - City:BAY SHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706-4635
Mailing Address - Country:US
Mailing Address - Phone:631-942-8182
Mailing Address - Fax:
Practice Address - Street 1:200 CARLETON AVE STE D
Practice Address - Street 2:
Practice Address - City:EAST ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11730-1222
Practice Address - Country:US
Practice Address - Phone:631-579-3503
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-22
Last Update Date:2022-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012404101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health