Provider Demographics
NPI:1043217201
Name:BAILEY, KAROL ANN (PHD)
Entity Type:Individual
Prefix:DR
First Name:KAROL
Middle Name:ANN
Last Name:BAILEY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6475 E PACIFIC COAST HWY
Mailing Address - Street 2:414
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90803-4201
Mailing Address - Country:US
Mailing Address - Phone:562-431-3423
Mailing Address - Fax:
Practice Address - Street 1:212 MAIN ST STE A3
Practice Address - Street 2:
Practice Address - City:SEAL BEACH
Practice Address - State:CA
Practice Address - Zip Code:90740-6378
Practice Address - Country:US
Practice Address - Phone:562-431-3423
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-02
Last Update Date:2013-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY5100103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACP5100AMedicare ID - Type Unspecified
CAR25839Medicare UPIN