Provider Demographics
NPI:1275510265
Name:BAILEY, MARCIA L (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:MARCIA
Middle Name:L
Last Name:BAILEY
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:MARCIA
Other - Middle Name:
Other - Last Name:BAILEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW, LCSW
Mailing Address - Street 1:1020 S MAIN ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84101-3115
Mailing Address - Country:US
Mailing Address - Phone:801-539-7000
Mailing Address - Fax:801-539-7050
Practice Address - Street 1:1020 S MAIN ST
Practice Address - Street 2:SUITE 100
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84101-3115
Practice Address - Country:US
Practice Address - Phone:801-539-7000
Practice Address - Fax:801-539-7050
Is Sole Proprietor?:No
Enumeration Date:2005-12-29
Last Update Date:2012-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT344965-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT107018085101OtherIHC
UTU000076255OtherMEDICARE
UT311133OtherDESERET MUTUAL
UT942938348MAROtherEDUCATORS MUTUAL
UT03449653501001OtherBLUE CROSS
UT003104004Medicare ID - Type UnspecifiedRAILROAD MEDICARE
UTP13861Medicare ID - Type UnspecifiedMEDICARE ADVANTAGE
UT03449653501001OtherBLUE CROSS
UT311133OtherDESERET MUTUAL