Healthcare Provider Details

I. General information

NPI: 1700743002
Provider Name (Legal Business Name): KELLY ANN BALDWIN LCSW, CCM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/07/2026
Last Update Date: 01/07/2026
Certification Date: 01/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1125 SUNSET PL
BETHLEHEM PA
18017-3634
US

IV. Provider business mailing address

1125 SUNSET PL
BETHLEHEM PA
18017-3634
US

V. Phone/Fax

Practice location:
  • Phone: 484-547-5776
  • Fax:
Mailing address:
  • Phone: 484-547-5776
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW025969
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: