Provider Demographics
NPI:1164433942
Name:BAILEY, CHAUNDRA (LCSW)
Entity Type:Individual
Prefix:
First Name:CHAUNDRA
Middle Name:
Last Name:BAILEY
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 1:60 CONNOLLY PKWY
Mailing Address - Street 2:SUITE B ROOM 108
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06514-2593
Mailing Address - Country:US
Mailing Address - Phone:203-230-1831
Mailing Address - Fax:203-230-1831
Practice Address - Street 1:60 CONNOLLY PKWY
Practice Address - Street 2:SUITE B ROOM 108
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06514-2593
Practice Address - Country:US
Practice Address - Phone:203-230-1831
Practice Address - Fax:203-230-1831
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0056311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical