Provider Demographics
NPI:1396218384
Name:FAIRHURST, BAYLEE
Entity Type:Individual
Prefix:
First Name:BAYLEE
Middle Name:
Last Name:FAIRHURST
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 CRAIGIE ST # 3
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02143-2401
Mailing Address - Country:US
Mailing Address - Phone:203-592-9091
Mailing Address - Fax:
Practice Address - Street 1:86 BAKER AVENUE EXT STE 100
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:MA
Practice Address - Zip Code:01742-2132
Practice Address - Country:US
Practice Address - Phone:978-369-1113
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-02
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program