Healthcare Provider Details

I. General information

NPI: 1366975138
Provider Name (Legal Business Name): BAILEY HUNTER MT-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2017
Last Update Date: 11/14/2023
Certification Date: 11/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

59 S COUNTY COMMONS WAY
WAKEFIELD RI
02879-8270
US

IV. Provider business mailing address

365 W PASSAIC ST
ROCHELLE PARK NJ
07662-3017
US

V. Phone/Fax

Practice location:
  • Phone: 401-783-4810
  • Fax:
Mailing address:
  • Phone: 973-264-0023
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License NumberMUS00008
License Number StateRI
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number44SL07034800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: