Provider Demographics
NPI:1174562342
Name:BALDWIN, STEPHANIE BAKYTA (LCSW-R)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:BAKYTA
Last Name:BALDWIN
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:BAKYTA
Other - Last Name:SELTZER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:55 E MAIN ST
Mailing Address - Street 2:SUITE 220
Mailing Address - City:JOHNSTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:12095-2633
Mailing Address - Country:US
Mailing Address - Phone:518-736-1100
Mailing Address - Fax:518-736-1101
Practice Address - Street 1:55 E MAIN ST
Practice Address - Street 2:SUITE 220
Practice Address - City:JOHNSTOWN
Practice Address - State:NY
Practice Address - Zip Code:12095-2633
Practice Address - Country:US
Practice Address - Phone:518-736-1100
Practice Address - Fax:518-736-1101
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2015-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR073012-11041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ2979OtherBCBS
NYRB 6474OtherMEDICARE