Provider Demographics
NPI:1831343060
Name:BALDWIN, CARLITA R (PHD)
Entity type:Individual
Prefix:DR
First Name:CARLITA
Middle Name:R
Last Name:BALDWIN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:366 ASH STREET
Mailing Address - Street 2:UNIT 4
Mailing Address - City:WILLIMANTIC
Mailing Address - State:CT
Mailing Address - Zip Code:06226
Mailing Address - Country:US
Mailing Address - Phone:860-465-9158
Mailing Address - Fax:
Practice Address - Street 1:366 ASH STREET
Practice Address - Street 2:UNIT 4
Practice Address - City:WILLIMANTIC
Practice Address - State:CT
Practice Address - Zip Code:06226
Practice Address - Country:US
Practice Address - Phone:860-465-9158
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-14
Last Update Date:2010-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103TC1900X, 101YA0400X
MD101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)