Healthcare Provider Details

I. General information

NPI: 1770065138
Provider Name (Legal Business Name): QUINTIN BAILEY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: QUINTIN CROWNOVER PSYD

II. Dates (important events)

Enumeration Date: 09/02/2018
Last Update Date: 07/11/2026
Certification Date: 07/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2715 VIOLA ST
OAKLAND CA
94619-1064
US

IV. Provider business mailing address

2715 VIOLA ST
OAKLAND CA
94619-1064
US

V. Phone/Fax

Practice location:
  • Phone: 737-900-3680
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number34961
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number39158
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6301019627
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: