MEDICARE: BALDWIN PSYCHOLOGICAL CONSULTANTS, LLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TP2701X	Group Psychotherapy Psychologist	004050	NY

General Provider Information

NPI Number	:	1801826557
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BALDWIN PSYCHOLOGICAL CONSULTANTS, LLP

Provider Business Mailing Address
First Line	:	865 MERRICK RD
Second Line	:	SUITE 305
City	:	BALDWIN
State	:	NY
Zip	:	11510-3338
Country	:	US
Telephone Number	:	516-868-3421
Fax Number	:	516-623-3644

Provider Business Practice Location Address
First Line	:	1311 VIRGINIA ST
Second Line	:
City	:	FAR ROCKAWAY
State	:	NY
Zip	:	11691-4630
Country	:	US
Telephone Number	:	718-327-2909
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	DR. ALAN KLAT
Credential	:	PH.D.
Telephone Number	:	516-868-3421

Provider Enumeration Date	:	07/04/2006
Last Update Date	:	08/22/2020

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