Provider Demographics
NPI:1578718532
Name:BAIL, PAUL (PHD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:
Last Name:BAIL
Suffix:
Gender:M
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:PO BOX 7551
Mailing Address - Street 2:
Mailing Address - City:FITCHBURG
Mailing Address - State:MA
Mailing Address - Zip Code:01420-0023
Mailing Address - Country:US
Mailing Address - Phone:978-821-4430
Mailing Address - Fax:
Practice Address - Street 1:2 BEVERLY DR
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:MA
Practice Address - Zip Code:01564-2150
Practice Address - Country:US
Practice Address - Phone:978-821-4430
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-18
Last Update Date:2008-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3925103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical