Provider Demographics
NPI:1811181431
Name:BALDWIN, COOPER A (LCSW)
Entity type:Individual
Prefix:MR
First Name:COOPER
Middle Name:A
Last Name:BALDWIN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:DR
Other - First Name:COOPER
Other - Middle Name:A
Other - Last Name:BALDWIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD
Mailing Address - Street 1:509 W 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99501-2236
Mailing Address - Country:US
Mailing Address - Phone:907-907-2799
Mailing Address - Fax:
Practice Address - Street 1:509 W 3RD AVE
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99501-2236
Practice Address - Country:US
Practice Address - Phone:907-279-9636
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-28
Last Update Date:2017-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6066022-3501041C0700X
WY4831041C0700X
AK10171041C0700X
AZ140791041C0700X
NV5743-C1041C0700X
ID305441041C0700X
MT136281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical