=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952241168
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BASELINE THERAPEUTIC SERVICES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/30/2026
-----------------------------------------------------
Last Update Date | 03/30/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 177 MAIN RD
-----------------------------------------------------
City | LEHIGHTON
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18235-2310
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-577-6092
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 371 S 2ND ST
-----------------------------------------------------
City | LEHIGHTON
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18235-2145
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/OPERATOR
-----------------------------------------------------
Name | JONATHAN M BLACKWELL-RODGERS
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 610-577-6092
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------