Provider Demographics
NPI:1326622457
Name:BAILEY, FREDERICK THOMAS IV (LCSW)
Entity Type:Individual
Prefix:MR
First Name:FREDERICK
Middle Name:THOMAS
Last Name:BAILEY
Suffix:IV
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9281 LILLIAN LN
Mailing Address - Street 2:
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80229-7680
Mailing Address - Country:US
Mailing Address - Phone:773-401-5775
Mailing Address - Fax:
Practice Address - Street 1:9281 LILLIAN LN
Practice Address - Street 2:
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80229-7680
Practice Address - Country:US
Practice Address - Phone:773-401-5775
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-05
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCSW.099261981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical