Healthcare Provider Details

I. General information

NPI: 1043217201
Provider Name (Legal Business Name): KAROL ANN BAILEY PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2005
Last Update Date: 01/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

212 MAIN ST STE A3
SEAL BEACH CA
90740-6378
US

IV. Provider business mailing address

6475 E PACIFIC COAST HWY 414
LONG BEACH CA
90803-4201
US

V. Phone/Fax

Practice location:
  • Phone: 562-431-3423
  • Fax:
Mailing address:
  • Phone: 562-431-3423
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY5100
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: