Provider Demographics
NPI:1821217225
Name:BAILEY, VICTORIA C (LCSW)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:C
Last Name:BAILEY
Suffix:
Gender:F
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:PO BOX 423
Mailing Address - Street 2:
Mailing Address - City:GRAHAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12740-0423
Mailing Address - Country:US
Mailing Address - Phone:845-985-0137
Mailing Address - Fax:845-985-0137
Practice Address - Street 1:383 DENMAN MOUNTAIN ROAD
Practice Address - Street 2:
Practice Address - City:GRAHAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:12740
Practice Address - Country:US
Practice Address - Phone:845-985-0137
Practice Address - Fax:845-985-0137
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0407851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical