Provider Demographics
NPI:1073917365
Name:MALONEY BAILEY, ERIN M
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:M
Last Name:MALONEY BAILEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2740 PROSPERITY AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-4353
Mailing Address - Country:US
Mailing Address - Phone:703-289-7561
Mailing Address - Fax:703-204-9001
Practice Address - Street 1:2740 PROSPERITY AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-4353
Practice Address - Country:US
Practice Address - Phone:703-289-7561
Practice Address - Fax:703-204-9001
Is Sole Proprietor?:No
Enumeration Date:2014-10-15
Last Update Date:2014-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810004992103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical