Healthcare Provider Details

I. General information

NPI: 1154483709
Provider Name (Legal Business Name): CAROLYN JOY BAILEY L.M.H.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 MAPLE ST SUITE 204
MIDDLETON MA
01949-2200
US

IV. Provider business mailing address

PO BOX 267
AMESBURY MA
01913-0007
US

V. Phone/Fax

Practice location:
  • Phone: 978-352-5325
  • Fax: 978-777-9974
Mailing address:
  • Phone: 978-352-5325
  • Fax: 978-777-9974

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number4266
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: