Healthcare Provider Details

I. General information

NPI: 1164874210
Provider Name (Legal Business Name): JOSHUA E BARON LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2016
Last Update Date: 03/08/2021
Certification Date: 01/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2025 E BELTLINE AVE SE STE 102
GRAND RAPIDS MI
49546-7673
US

IV. Provider business mailing address

2025 E BELTLINE AVE SE STE 102
GRAND RAPIDS MI
49546-7673
US

V. Phone/Fax

Practice location:
  • Phone: 616-920-6445
  • Fax:
Mailing address:
  • Phone: 616-920-6445
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801108328
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: