Provider Demographics
NPI:1326182825
Name:BAILE, BETSY JANE (MSSW,QCSW,LCSW)
Entity Type:Individual
Prefix:MS
First Name:BETSY
Middle Name:JANE
Last Name:BAILE
Suffix:
Gender:F
Credentials:MSSW,QCSW,LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:319A N CANE ST
Mailing Address - Street 2:
Mailing Address - City:WAHIAWA
Mailing Address - State:HI
Mailing Address - Zip Code:96786-2109
Mailing Address - Country:US
Mailing Address - Phone:808-621-1820
Mailing Address - Fax:808-621-0540
Practice Address - Street 1:319A N CANE ST
Practice Address - Street 2:
Practice Address - City:WAHIAWA
Practice Address - State:HI
Practice Address - Zip Code:96786-2109
Practice Address - Country:US
Practice Address - Phone:808-621-1820
Practice Address - Fax:808-621-0540
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HILCSW 30861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI541153 01Medicaid