Provider Demographics
NPI:1417428210
Name:BAILEY, JONATHAN
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:
Last Name:BAILEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 SOUTHWICK ST
Mailing Address - Street 2:
Mailing Address - City:FEEDING HILLS
Mailing Address - State:MA
Mailing Address - Zip Code:01030-2024
Mailing Address - Country:US
Mailing Address - Phone:413-786-6410
Mailing Address - Fax:413-789-9623
Practice Address - Street 1:30 SOUTHWICK ST
Practice Address - Street 2:
Practice Address - City:FEEDING HILLS
Practice Address - State:MA
Practice Address - Zip Code:01030-2024
Practice Address - Country:US
Practice Address - Phone:413-786-6410
Practice Address - Fax:413-789-9623
Is Sole Proprietor?:No
Enumeration Date:2018-12-06
Last Update Date:2019-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health