Healthcare Provider Details

I. General information

NPI: 1891069332
Provider Name (Legal Business Name): MS. JILLIAN NOEL BALDWIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2012
Last Update Date: 10/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 LACEY RD STE 3
FORKED RIVER NJ
08731-2200
US

IV. Provider business mailing address

615 LACEY RD STE 3
FORKED RIVER NJ
08731-2200
US

V. Phone/Fax

Practice location:
  • Phone: 609-242-3322
  • Fax:
Mailing address:
  • Phone: 609-242-3322
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-12-12637
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: