Healthcare Provider Details

I. General information

NPI: 1902204852
Provider Name (Legal Business Name): CARA BAILEY LMSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2014
Last Update Date: 12/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24445 NORTHWESTERN HWY SUITE 100
SOUTHFIELD MI
48075-6501
US

IV. Provider business mailing address

21001 GREEN HILL RD APT. 276
FARMINGTON HILLS MI
48335-4510
US

V. Phone/Fax

Practice location:
  • Phone: 248-483-7804
  • Fax:
Mailing address:
  • Phone: 913-223-0030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801097355
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2012009438
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: