Provider Demographics
NPI:1487167201
Name:BALDWIN, QUENTIN J
Entity type:Individual
Prefix:
First Name:QUENTIN
Middle Name:J
Last Name:BALDWIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6147 SUTTER AVE
Mailing Address - Street 2:
Mailing Address - City:CARMICHAEL
Mailing Address - State:CA
Mailing Address - Zip Code:95608-2738
Mailing Address - Country:US
Mailing Address - Phone:916-971-7640
Mailing Address - Fax:
Practice Address - Street 1:3050 BEACON BLVD STE 103
Practice Address - Street 2:
Practice Address - City:WEST SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95691-3467
Practice Address - Country:US
Practice Address - Phone:916-462-3100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-15
Last Update Date:2023-08-24
Deactivation Date:2019-07-22
Deactivation Code:
Reactivation Date:2019-07-31
Provider Licenses
StateLicense IDTaxonomies
171M00000X
CA172V00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health