MEDICARE: DR. KAROL ANN BAILEY PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	PSY5100	CA

General Provider Information

NPI Number	:	1043217201
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KAROL ANN BAILEY PH.D.

Provider Business Mailing Address
First Line	:	6475 E PACIFIC COAST HWY
Second Line	:	414
City	:	LONG BEACH
State	:	CA
Zip	:	90803-4201
Country	:	US
Telephone Number	:	562-431-3423
Fax Number	:

Provider Business Practice Location Address
First Line	:	212 MAIN ST STE A3
Second Line	:
City	:	SEAL BEACH
State	:	CA
Zip	:	90740-6378
Country	:	US
Telephone Number	:	562-431-3423
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/02/2005
Last Update Date	:	01/30/2013

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