Provider Demographics
NPI:1669821575
Name:BAILEY, MARY ELLEN (LCSW)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ELLEN
Last Name:BAILEY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:ELLEN BAILEY
Other - Last Name:ELLIOTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:8007 LADY LEWIS CT
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22153-2702
Mailing Address - Country:US
Mailing Address - Phone:703-539-2183
Mailing Address - Fax:
Practice Address - Street 1:8007 LADY LEWIS CT
Practice Address - Street 2:TELEHEALTH
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22153-2702
Practice Address - Country:US
Practice Address - Phone:703-539-2183
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-10
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0904009491104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker