Provider Demographics
NPI:1255406070
Name:BAILEY, SANDRA BROOKS (LISW ACSW)
Entity type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:BROOKS
Last Name:BAILEY
Suffix:
Gender:F
Credentials:LISW ACSW
Other - Prefix:MS
Other - First Name:SANDRA
Other - Middle Name:K
Other - Last Name:BROOKS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:5930 HEISLEY RD
Mailing Address - Street 2:
Mailing Address - City:MENTOR
Mailing Address - State:OH
Mailing Address - Zip Code:44060
Mailing Address - Country:US
Mailing Address - Phone:440-354-9924
Mailing Address - Fax:440-354-5808
Practice Address - Street 1:5930 HEISLEY RD
Practice Address - Street 2:
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060
Practice Address - Country:US
Practice Address - Phone:440-354-9924
Practice Address - Fax:440-354-5808
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI0004914104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker