Healthcare Provider Details

I. General information

NPI: 1083432587
Provider Name (Legal Business Name): SARA BALDRICK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2024
Last Update Date: 03/16/2026
Certification Date: 03/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2211 FULTON AVE
CINCINNATI OH
45206-2504
US

IV. Provider business mailing address

322 N MIAMI AVE
CLEVES OH
45002-1023
US

V. Phone/Fax

Practice location:
  • Phone: 513-961-4863
  • Fax:
Mailing address:
  • Phone: 513-692-8463
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDCA.192459
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberAPS.005563
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: