Provider Demographics
NPI:1881892248
Name:BALDWIN, DANIEL (LCSW)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:BALDWIN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1421 LAKE SHORE DR
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:IN
Mailing Address - Zip Code:46360-1452
Mailing Address - Country:US
Mailing Address - Phone:219-362-2145
Mailing Address - Fax:219-362-1143
Practice Address - Street 1:450 ST JOHNS ROAD
Practice Address - Street 2:
Practice Address - City:MICHIGAN CITY
Practice Address - State:IN
Practice Address - Zip Code:46360
Practice Address - Country:US
Practice Address - Phone:219-872-4621
Practice Address - Fax:219-873-2388
Is Sole Proprietor?:No
Enumeration Date:2007-07-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34005081A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN485390Medicare ID - Type UnspecifiedGROUP NUMBER