Provider Demographics
NPI:1962912402
Name:BALDWIN, JUSTINE HEATHER ROSE (PSYD)
Entity type:Individual
Prefix:DR
First Name:JUSTINE
Middle Name:HEATHER ROSE
Last Name:BALDWIN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:JUSTINE
Other - Middle Name:HEATHER ROSE
Other - Last Name:GRAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:24 LAURIE RD
Mailing Address - Street 2:
Mailing Address - City:CORTLANDT MANOR
Mailing Address - State:NY
Mailing Address - Zip Code:10567-1412
Mailing Address - Country:US
Mailing Address - Phone:914-960-6232
Mailing Address - Fax:
Practice Address - Street 1:17273 STATE ROUTE 104
Practice Address - Street 2:
Practice Address - City:CHILLICOTHE
Practice Address - State:OH
Practice Address - Zip Code:45601-9718
Practice Address - Country:US
Practice Address - Phone:740-773-1141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-11
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist