Provider Demographics
NPI:1851752901
Name:BAILEY, GLORIA (LCSW)
Entity Type:Individual
Prefix:
First Name:GLORIA
Middle Name:
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 1:4533 DREXEL RD
Mailing Address - Street 2:
Mailing Address - City:LAND O LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:34638-3605
Mailing Address - Country:US
Mailing Address - Phone:727-641-8497
Mailing Address - Fax:
Practice Address - Street 1:14901 CRISIS CENTER PLZ
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-1238
Practice Address - Country:US
Practice Address - Phone:813-264-9955
Practice Address - Fax:813-868-3996
Is Sole Proprietor?:No
Enumeration Date:2016-03-17
Last Update Date:2016-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW135301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical