Healthcare Provider Details

I. General information

NPI: 1811331309
Provider Name (Legal Business Name): GENNIE BAILEY LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: GENNIE BROTHERS

II. Dates (important events)

Enumeration Date: 04/26/2013
Last Update Date: 09/06/2024
Certification Date: 09/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 SPRINGFIELD ST STE 522A
THREE RIVERS MA
01080-1242
US

IV. Provider business mailing address

PO BOX 1
THREE RIVERS MA
01080-0001
US

V. Phone/Fax

Practice location:
  • Phone: 413-893-4462
  • Fax:
Mailing address:
  • Phone: 413-893-4462
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number10413
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number003275
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: