Healthcare Provider Details

I. General information

NPI: 1508019332
Provider Name (Legal Business Name): ELAINE T BAILEY PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2008
Last Update Date: 10/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UVA HOSPITAL WEST HOSPITAL DRI VE, 4TH FLOOR
CHARLOTTESVILLE VA
22908-0001
US

IV. Provider business mailing address

PO BOX 9007
CHARLOTTESVILLE VA
22906-9007
US

V. Phone/Fax

Practice location:
  • Phone: 434-924-5314
  • Fax: 434-924-0185
Mailing address:
  • Phone: 434-295-1000
  • Fax: 434-972-4266

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0810003926
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: