Provider Demographics
NPI:1598970600
Name:BAILEY, NAWAN OWEN (LCSW)
Entity Type:Individual
Prefix:MR
First Name:NAWAN
Middle Name:OWEN
Last Name:BAILEY
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 1:124 E 118TH ST
Mailing Address - Street 2:#3F
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10035-3917
Mailing Address - Country:US
Mailing Address - Phone:917-576-0289
Mailing Address - Fax:
Practice Address - Street 1:136 E 57TH ST
Practice Address - Street 2:SUTIE 405
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-2707
Practice Address - Country:US
Practice Address - Phone:212-252-5560
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR056306-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical