Provider Demographics
NPI:1326665191
Name:MARSHALL, BAILEY C (MSW, LICSW)
Entity Type:Individual
Prefix:
First Name:BAILEY
Middle Name:C
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 STRATHMORE RD APT 45
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02135-7163
Mailing Address - Country:US
Mailing Address - Phone:610-937-5674
Mailing Address - Fax:
Practice Address - Street 1:90 WELLS AVE
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02459-3210
Practice Address - Country:US
Practice Address - Phone:617-969-6130
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-28
Last Update Date:2020-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1226621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical