Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | PSY16063 | CA |
Y | 103TC0700X | Clinical Psychologist | PSY16063 | CA |
NPI | 1003927070 |
---|---|
Provider Name | Gordon Baldwin |
First Address | Carmichael, CA 95608-2738 |
Second Address | Carmichael, CA 95608-2738 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2006 |
Last Update Date | 08/07/2007 |