Healthcare Provider Details

I. General information

NPI: 1306240569
Provider Name (Legal Business Name): ALLIE BALDWIN M.A., BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2014
Last Update Date: 10/21/2020
Certification Date: 10/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8001 CREST AVE
OAKLAND CA
94605-3611
US

IV. Provider business mailing address

8001 CREST AVE
OAKLAND CA
94605-3611
US

V. Phone/Fax

Practice location:
  • Phone: 925-232-1043
  • Fax: 925-523-0903
Mailing address:
  • Phone: 925-232-1043
  • Fax: 925-523-0903

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-14-10122
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: