Provider Demographics
NPI:1902202484
Name:COGAN BAILEY, CAREY (LCSW)
Entity Type:Individual
Prefix:
First Name:CAREY
Middle Name:
Last Name:COGAN 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 1:2643 APPIAN WAY
Mailing Address - Street 2:A-3
Mailing Address - City:PINOLE
Mailing Address - State:CA
Mailing Address - Zip Code:94564-2263
Mailing Address - Country:US
Mailing Address - Phone:510-390-1732
Mailing Address - Fax:510-669-1798
Practice Address - Street 1:2643 APPIAN WAY
Practice Address - Street 2:A-3
Practice Address - City:PINOLE
Practice Address - State:CA
Practice Address - Zip Code:94564-2263
Practice Address - Country:US
Practice Address - Phone:510-390-1732
Practice Address - Fax:510-669-1798
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-11
Last Update Date:2014-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA211781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical