Provider Demographics
NPI:1912342130
Name:BALDWIN, DENISE
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:
Last Name:BALDWIN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 626
Mailing Address - Street 2:
Mailing Address - City:GOSHEN
Mailing Address - State:CA
Mailing Address - Zip Code:93227-0626
Mailing Address - Country:US
Mailing Address - Phone:559-310-9710
Mailing Address - Fax:
Practice Address - Street 1:820 N AMERICAN ST
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95202-1824
Practice Address - Country:US
Practice Address - Phone:209-865-1469
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-01
Last Update Date:2025-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT35706164X00000X
101YA0400X
CA113807104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No164X00000XNursing Service ProvidersLicensed Vocational Nurse
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)