Provider Demographics
NPI:1366589798
Name:BALDT, PATRICIA C (LCSW R)
Entity type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:C
Last Name:BALDT
Suffix:
Gender:F
Credentials:LCSW R
Other - Prefix:
Other - First Name:ANNA
Other - Middle Name:PATRICIA
Other - Last Name:BALDT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSWR
Mailing Address - Street 1:68 GERALD DRIVE
Mailing Address - Street 2:APT E3
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12601-2923
Mailing Address - Country:US
Mailing Address - Phone:845-485-2183
Mailing Address - Fax:845-452-2954
Practice Address - Street 1:11 MARSHALL RD
Practice Address - Street 2:SUITE 2L
Practice Address - City:WAPPINGARS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12590
Practice Address - Country:US
Practice Address - Phone:914-475-4947
Practice Address - Fax:845-452-2954
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2010-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYNYR0403261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
N74772Medicare ID - Type Unspecified