Provider Demographics
NPI:1982852935
Name:BAILLIE, JEANINE ELIZABETH
Entity Type:Individual
Prefix:MISS
First Name:JEANINE
Middle Name:ELIZABETH
Last Name:BAILLIE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 HILLSIDE ST
Mailing Address - Street 2:APT #2
Mailing Address - City:ROXBURY CROSSING
Mailing Address - State:MA
Mailing Address - Zip Code:02120-3349
Mailing Address - Country:US
Mailing Address - Phone:617-519-0048
Mailing Address - Fax:
Practice Address - Street 1:11 HILLSIDE ST
Practice Address - Street 2:APT #2
Practice Address - City:ROXBURY CROSSING
Practice Address - State:MA
Practice Address - Zip Code:02120-3349
Practice Address - Country:US
Practice Address - Phone:617-519-0048
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-03
Last Update Date:2008-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor