Provider Demographics
NPI:1952815581
Name:BALDY, JOHN (LMCH; SCHOOL PSYCH)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:BALDY
Suffix:
Gender:M
Credentials:LMCH; SCHOOL PSYCH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:LAS VEGAS CITY SCHOOLS
Mailing Address - Street 2:901 DOUGLAS AVE.
Mailing Address - City:LAS VEGAS
Mailing Address - State:NM
Mailing Address - Zip Code:87701
Mailing Address - Country:US
Mailing Address - Phone:505-429-0022
Mailing Address - Fax:
Practice Address - Street 1:901 DOUGLAS AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NM
Practice Address - Zip Code:87701-3928
Practice Address - Country:US
Practice Address - Phone:505-429-0022
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM376037103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool