Provider Demographics
NPI:1942210141
Name:BAILEY-YELDER, DWAN (LCSW, BACS)
Entity Type:Individual
Prefix:MS
First Name:DWAN
Middle Name:
Last Name:BAILEY-YELDER
Suffix:
Gender:F
Credentials:LCSW, BACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4717 FRERET ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70115-6320
Mailing Address - Country:US
Mailing Address - Phone:504-610-3140
Mailing Address - Fax:
Practice Address - Street 1:118 TERRY PKWY
Practice Address - Street 2:
Practice Address - City:TERRYTOWN
Practice Address - State:LA
Practice Address - Zip Code:70056-2523
Practice Address - Country:US
Practice Address - Phone:504-601-3140
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA74501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA4H511Medicare ID - Type Unspecified