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General NPI Number Information
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NPI Number | 1508921917
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Entity Type | Individual
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Provider Name | GLENN THOMAS BAILEY PHD
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Gender | Male
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Dates
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Enumeration Date | 12/26/2006
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Last Update Date | 01/28/2025
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Provider Practice Location Address
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Address Line | 1700 CACAPON CT
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City | VIRGINIA BEACH
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State | VA
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Zip | 23454-6713
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Country | US
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Telephone | 814-528-2512
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Fax |
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Provider Business Mailing Address
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Address Line | 4000 STERRETTANIA RD
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City | ERIE
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State | PA
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Zip | 16506-4125
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Country | US
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Telephone | 814-454-4285
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Fax | 814-520-8490
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PS005734L
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License Number State | PA
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