Provider Demographics
NPI:1962635581
Name:HAILEY, IRIS A (LICSW)
Entity Type:Individual
Prefix:MS
First Name:IRIS
Middle Name:A
Last Name:HAILEY
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 MOUNT VERNON ST
Mailing Address - Street 2:S233
Mailing Address - City:WINCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01890-2704
Mailing Address - Country:US
Mailing Address - Phone:781-255-0070
Mailing Address - Fax:866-442-9954
Practice Address - Street 1:1500 PROVIDENCE HWY
Practice Address - Street 2:S22B
Practice Address - City:NORWOOD
Practice Address - State:MA
Practice Address - Zip Code:02062-4630
Practice Address - Country:US
Practice Address - Phone:780-255-0070
Practice Address - Fax:866-442-9954
Is Sole Proprietor?:No
Enumeration Date:2009-08-30
Last Update Date:2009-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA115175101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health