Provider Demographics
NPI:1063616688
Name:BALDWIN, DAVID MCGRATH JR (PHD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:MCGRATH
Last Name:BALDWIN
Suffix:JR
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1772 MITCHELL CT
Mailing Address - Street 2:
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32128-6760
Mailing Address - Country:US
Mailing Address - Phone:802-558-4246
Mailing Address - Fax:
Practice Address - Street 1:1772 MITCHELL CT
Practice Address - Street 2:
Practice Address - City:PORT ORANGE
Practice Address - State:FL
Practice Address - Zip Code:32128-6760
Practice Address - Country:US
Practice Address - Phone:802-558-4246
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-14
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY9154103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical