Provider Demographics
NPI:1538479738
Name:BAIR, CODY DANIEL (LCSW)
Entity Type:Individual
Prefix:MR
First Name:CODY
Middle Name:DANIEL
Last Name:BAIR
Suffix:
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 1:109 GRIZZLY LN
Mailing Address - Street 2:
Mailing Address - City:MADISONBURG
Mailing Address - State:PA
Mailing Address - Zip Code:16852-8013
Mailing Address - Country:US
Mailing Address - Phone:814-380-4697
Mailing Address - Fax:
Practice Address - Street 1:925 W COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16801-2804
Practice Address - Country:US
Practice Address - Phone:814-380-4697
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-21
Last Update Date:2018-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC139531041C0700X
PACW0194341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical