Healthcare Provider Details

I. General information

NPI: 1336692458
Provider Name (Legal Business Name): NANDI BALDWIN MA, LMHC, NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2016
Last Update Date: 05/06/2020
Certification Date: 05/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5608 ZUNI RD SE
ALBUQUERQUE NM
87108-2926
US

IV. Provider business mailing address

11024 MONTGOMERY BLVD NE
ALBUQUERQUE NM
87111-3962
US

V. Phone/Fax

Practice location:
  • Phone: 505-262-2481
  • Fax:
Mailing address:
  • Phone: 505-550-1407
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCCMH0211061
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: