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General NPI Number Information
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NPI Number | 1235855818
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Entity Type | Individual
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Provider Name | MICHELLE BLISS BAYLES LCSW
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Gender | Female
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Dates
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Enumeration Date | 10/17/2022
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Last Update Date | 11/07/2024
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Provider Practice Location Address
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Address Line | 413 CENTRAL AVE UNIT 10-314
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City | PAWTUCKET
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State | RI
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Zip | 02861-2080
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Country | US
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Telephone | 423-310-8823
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Fax |
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Provider Business Mailing Address
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Address Line | 413 CENTRAL AVE UNIT 10-314
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City | PAWTUCKET
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State | RI
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Zip | 02861-2080
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Country | US
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Telephone | 423-310-8823
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | LCSW2120858
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License Number State | MA
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