Provider Demographics
NPI:1245510015
Name:BAILEY, JOHN SCOTT (M DIV)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:SCOTT
Last Name:BAILEY
Suffix:
Gender:M
Credentials:M DIV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 GARFIELD ST
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-4114
Mailing Address - Country:US
Mailing Address - Phone:617-479-4043
Mailing Address - Fax:617-479-3004
Practice Address - Street 1:24 GARFIELD ST
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-4114
Practice Address - Country:US
Practice Address - Phone:617-479-4043
Practice Address - Fax:617-479-3004
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-24
Last Update Date:2011-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health