Provider Demographics
NPI:1295028835
Name:BAYLIS, ESTHER SHALVA (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:ESTHER
Middle Name:SHALVA
Last Name:BAYLIS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:ESTHER
Other - Middle Name:SHALVA
Other - Last Name:MEIR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:136 COLUMBIA BLVD
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06710-1704
Mailing Address - Country:US
Mailing Address - Phone:347-757-0164
Mailing Address - Fax:
Practice Address - Street 1:34 MURRAY ST
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06710-1920
Practice Address - Country:US
Practice Address - Phone:203-756-8317
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-16
Last Update Date:2015-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
CT0089141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker