MEDICARE: BAILEY HUNTER MT-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225A00000X	Music Therapist	MUS00008	RI
2	104100000X	Social Worker	44SL07034800	NJ

General Provider Information

NPI Number	:	1366975138
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BAILEY HUNTER MT-BC

Provider Business Mailing Address
First Line	:	365 W PASSAIC ST
Second Line	:
City	:	ROCHELLE PARK
State	:	NJ
Zip	:	07662-3017
Country	:	US
Telephone Number	:	973-264-0023
Fax Number	:

Provider Business Practice Location Address
First Line	:	59 S COUNTY COMMONS WAY
Second Line	:
City	:	WAKEFIELD
State	:	RI
Zip	:	02879-8270
Country	:	US
Telephone Number	:	401-783-4810
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/07/2017
Last Update Date	:	11/14/2023

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