Healthcare Provider Details

I. General information

NPI: 1558421909
Provider Name (Legal Business Name): PATRICIA J BALDUCCI LCSWC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2006
Last Update Date: 09/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29787 JOHN J WILLIAMS HWY UNIT 8
MILLSBORO DE
19966-4097
US

IV. Provider business mailing address

PO BOX 99
CONOWINGO MD
21918-0099
US

V. Phone/Fax

Practice location:
  • Phone: 800-818-8680
  • Fax: 800-818-8680
Mailing address:
  • Phone: 410-378-9696
  • Fax: 410-378-0787

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number03640
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberQ1-0001330
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: