Provider Demographics
NPI:1811331309
Name:BAILEY, GENNIE (LMHC)
Entity type:Individual
Prefix:MRS
First Name:GENNIE
Middle Name:
Last Name:BAILEY
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:GENNIE
Other - Middle Name:
Other - Last Name:BROTHERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1
Mailing Address - Street 2:
Mailing Address - City:THREE RIVERS
Mailing Address - State:MA
Mailing Address - Zip Code:01080-0001
Mailing Address - Country:US
Mailing Address - Phone:413-893-4462
Mailing Address - Fax:
Practice Address - Street 1:4 SPRINGFIELD ST STE 522A
Practice Address - Street 2:
Practice Address - City:THREE RIVERS
Practice Address - State:MA
Practice Address - Zip Code:01080-1242
Practice Address - Country:US
Practice Address - Phone:413-893-4462
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-26
Last Update Date:2024-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10413101YM0800X, 101YM0800X
CT003275101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1300881Medicaid