Healthcare Provider Details

I. General information

NPI: 1659385805
Provider Name (Legal Business Name): SHARON FELICIA BAILEY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 03/05/2025
Certification Date: 03/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5955 ZEAMER AVE
JBER AK
99506-3702
US

IV. Provider business mailing address

20211 46TH AVE
BAYSIDE NY
11361-3020
US

V. Phone/Fax

Practice location:
  • Phone: 907-580-0117
  • Fax:
Mailing address:
  • Phone: 347-829-2515
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number18464
License Number StateTX

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1624082-01
Identifier TypeMEDICAID
Identifier StateTX
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: