Provider Demographics
NPI:1083085781
Name:BAILEY, ROSETTA LOUISE (SSW)
Entity Type:Individual
Prefix:
First Name:ROSETTA
Middle Name:LOUISE
Last Name:BAILEY
Suffix:
Gender:F
Credentials:SSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18701 GRAND RIVER AVE # 205
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48223-2214
Mailing Address - Country:US
Mailing Address - Phone:313-702-2300
Mailing Address - Fax:313-693-9527
Practice Address - Street 1:28050 SOUTHFIELD RD
Practice Address - Street 2:
Practice Address - City:LATHRUP VILLAGE
Practice Address - State:MI
Practice Address - Zip Code:48076-2832
Practice Address - Country:US
Practice Address - Phone:313-702-2300
Practice Address - Fax:313-693-9527
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-07
Last Update Date:2015-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010661791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical