Provider Demographics
NPI:1275818205
Name:BAILEY, BOBBI A (LCSW)
Entity Type:Individual
Prefix:MS
First Name:BOBBI
Middle Name:A
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 1:1575 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13601-9371
Mailing Address - Country:US
Mailing Address - Phone:315-779-5060
Mailing Address - Fax:315-779-5028
Practice Address - Street 1:1575 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:NY
Practice Address - Zip Code:13601-9371
Practice Address - Country:US
Practice Address - Phone:315-779-5060
Practice Address - Fax:315-779-5028
Is Sole Proprietor?:No
Enumeration Date:2011-10-21
Last Update Date:2015-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY085027104100000X
NY083572-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker