Provider Demographics
NPI:1619257185
Name:BAILEY, ELVIRA L (MSSA, LISW S)
Entity Type:Individual
Prefix:
First Name:ELVIRA
Middle Name:L
Last Name:BAILEY
Suffix:
Gender:F
Credentials:MSSA, LISW S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2772 E 124TH ST
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44120-2153
Mailing Address - Country:US
Mailing Address - Phone:216-561-1637
Mailing Address - Fax:216-561-1637
Practice Address - Street 1:24300 CHAGRIN BLVD
Practice Address - Street 2:SUITE 303
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-5639
Practice Address - Country:US
Practice Address - Phone:216-392-1086
Practice Address - Fax:216-561-1637
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-28
Last Update Date:2011-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI 00084571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical