Provider Demographics
NPI:1528004629
Name:BAILEY, ELAINE M (PHD)
Entity Type:Individual
Prefix:
First Name:ELAINE
Middle Name:M
Last Name:BAILEY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1333 COLLEGE PARKWAY
Mailing Address - Street 2:SUITE 133
Mailing Address - City:GULF BREEZE
Mailing Address - State:FL
Mailing Address - Zip Code:32563-2711
Mailing Address - Country:US
Mailing Address - Phone:850-292-2797
Mailing Address - Fax:850-433-0268
Practice Address - Street 1:1333 COLLEGE PARKWAY
Practice Address - Street 2:SUITE 133
Practice Address - City:GULF BREEZE
Practice Address - State:FL
Practice Address - Zip Code:32563-2711
Practice Address - Country:US
Practice Address - Phone:850-292-2797
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2020-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY6581103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL54824ZMedicare PIN