Provider Demographics
NPI:1255075123
Name:BAILEY, ROBERT ALLEN (LCSW)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:ALLEN
Last Name:BAILEY
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5845 BLUEBERRY CT
Mailing Address - Street 2:
Mailing Address - City:LAUDERHILL
Mailing Address - State:FL
Mailing Address - Zip Code:33313-3081
Mailing Address - Country:US
Mailing Address - Phone:404-931-6968
Mailing Address - Fax:
Practice Address - Street 1:7520 NW 5TH ST STE 200
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33317-1613
Practice Address - Country:US
Practice Address - Phone:754-300-2972
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-26
Last Update Date:2024-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040175461041C0700X
FLSW229431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical