Provider Demographics
NPI:1114013992
Name:BAYLIS, PAULINE R (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:PAULINE
Middle Name:R
Last Name:BAYLIS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 BURGEE CT
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29229-7344
Mailing Address - Country:US
Mailing Address - Phone:803-708-3340
Mailing Address - Fax:
Practice Address - Street 1:18 BURGEE CT
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29229-7344
Practice Address - Country:US
Practice Address - Phone:803-708-3340
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2011-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR036262-1R1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN61851Medicare PIN