=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023557675
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KELLY BALDWIN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/15/2017
-----------------------------------------------------
Last Update Date | 02/15/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 20 CARPENTER PL
-----------------------------------------------------
City | YORKTOWN HEIGHTS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10598-6638
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 14-299-0531
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 20 CARPENTER PL
-----------------------------------------------------
City | YORKTOWN HEIGHTS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10598-6638
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 14-299-0531
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103K00000X
-----------------------------------------------------
Taxonomy Name | Behavior Analyst
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------