Healthcare Provider Details

I. General information

NPI: 1205283124
Provider Name (Legal Business Name): ELIZABETH S. BAILEY LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/20/2016
Last Update Date: 10/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 OLD DERBY ST STE 260
HINGHAM MA
02043-4064
US

IV. Provider business mailing address

160 OLD DERBY ST STE 260
HINGHAM MA
02043-4064
US

V. Phone/Fax

Practice location:
  • Phone: 781-783-7522
  • Fax:
Mailing address:
  • Phone: 781-783-7522
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number4837
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: