Healthcare Provider Details

I. General information

NPI: 1942640164
Provider Name (Legal Business Name): PATRICK BAILEY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

60 MERRIMACK ST
HAVERHILL MA
01830-6207
US

IV. Provider business mailing address

60 MERRIMACK ST
HAVERHILL MA
01830-6207
US

V. Phone/Fax

Practice location:
  • Phone: 978-521-7777
  • Fax: 978-521-7767
Mailing address:
  • Phone: 978-521-7777
  • Fax: 978-521-7767

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: