Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | 13426 | FL |
NPI | 1003163528 |
---|---|
Provider Name | Mr. Trevor Dean Baines |
First Address | Panama City, FL 32401-1366 |
Second Address | Panama City, FL 32401-1366 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/08/2012 |
Last Update Date | 13/06/2016 |