Healthcare Provider Details

I. General information

NPI: 1578153011
Provider Name (Legal Business Name): BAILEY MCLAUGHLIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2021
Last Update Date: 02/15/2022
Certification Date: 02/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 W BALTIMORE PIKE STE 100B
MEDIA PA
19063-5639
US

IV. Provider business mailing address

77 W BALTIMORE PIKE STE 100B
MEDIA PA
19063-5639
US

V. Phone/Fax

Practice location:
  • Phone: 610-572-5520
  • Fax: 610-572-5521
Mailing address:
  • Phone: 610-572-5520
  • Fax: 610-572-5521

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberBH005777
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-20-13909
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: