Provider Demographics
NPI:1750828059
Name:BAILEY, ERICA
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:
Last Name:BAILEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2480 CYPRESS POND RD
Mailing Address - Street 2:APT 1004
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34683-1537
Mailing Address - Country:US
Mailing Address - Phone:317-513-4743
Mailing Address - Fax:
Practice Address - Street 1:2480 CYPRESS POND RD
Practice Address - Street 2:APT 1004
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34683-1537
Practice Address - Country:US
Practice Address - Phone:317-513-4743
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-24
Last Update Date:2017-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN1-16-21637103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst