Healthcare Provider Details

I. General information

NPI: 1760685291
Provider Name (Legal Business Name): DINA BALDWIN BERDY LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2007
Last Update Date: 02/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2075 W BIG BEAVER RD STE 520
TROY MI
48084-3407
US

IV. Provider business mailing address

1631 W FARNUM AVE
ROYAL OAK MI
48067-1634
US

V. Phone/Fax

Practice location:
  • Phone: 248-646-6659
  • Fax: 248-642-8645
Mailing address:
  • Phone: 734-649-8756
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801084378
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: