Healthcare Provider Details

I. General information

NPI: 1881892248
Provider Name (Legal Business Name): DANIEL BALDWIN LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 ST JOHNS ROAD
MICHIGAN CITY IN
46360
US

IV. Provider business mailing address

1421 LAKE SHORE DR
LONG BEACH IN
46360-1452
US

V. Phone/Fax

Practice location:
  • Phone: 219-872-4621
  • Fax: 219-873-2388
Mailing address:
  • Phone: 219-362-2145
  • Fax: 219-362-1143

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number34005081A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: