Healthcare Provider Details

I. General information

NPI: 1811181431
Provider Name (Legal Business Name): COOPER A BALDWIN LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: COOPER A BALDWIN PSYD

II. Dates (important events)

Enumeration Date: 08/28/2007
Last Update Date: 01/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

509 W 3RD AVE
ANCHORAGE AK
99501-2236
US

IV. Provider business mailing address

509 W 3RD AVE
ANCHORAGE AK
99501-2236
US

V. Phone/Fax

Practice location:
  • Phone: 907-279-9636
  • Fax:
Mailing address:
  • Phone: 907-907-2799
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6066022-350
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number483
License Number StateWY
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1017
License Number StateAK
# 4
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number14079
License Number StateAZ
# 5
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number5743-C
License Number StateNV
# 6
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number30544
License Number StateID
# 7
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number13628
License Number StateMT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: