1366767675 NPI number — MS. COURTNEY A BAILEY MSW (MAY 2011)

Table of content: MS. COURTNEY A BAILEY MSW (MAY 2011) (NPI 1366767675)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366767675 NPI number — MS. COURTNEY A BAILEY MSW (MAY 2011)

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BAILEY
Provider First Name:
COURTNEY
Provider Middle Name:
A
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MSW (MAY 2011)
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1366767675
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/20/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
111 SOUTH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SOMERVILLE
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02143
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
617-284-5130
Provider Business Mailing Address Fax Number:
617-591-0239

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
111 SOUTH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOMERVILLE
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02143
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-284-5130
Provider Business Practice Location Address Fax Number:
617-591-0239
Provider Enumeration Date:
03/30/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 171M00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 104100000X , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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