Healthcare Provider Details

I. General information

NPI: 1497344642
Provider Name (Legal Business Name): LAURIE ELIZABETH BAILEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2021
Last Update Date: 05/25/2023
Certification Date: 05/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

579 COURTLAND AVENUE
BRONX NY
10451
US

IV. Provider business mailing address

12 E 132ND ST APT 3A
NEW YORK NY
10037-3419
US

V. Phone/Fax

Practice location:
  • Phone: 718-485-2100
  • Fax:
Mailing address:
  • Phone: 917-605-7499
  • Fax:

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: