MEDICARE: SAMANTHA BAILLIE MA LPC

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	101YM0800X	Mental Health Counselor	PC009083	PA
2	101Y00000X	Counselor	678	WY
3	101Y00000X	Counselor	1339	WY
4	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1053647990
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMANTHA BAILLIE MA LPC

Provider Business Mailing Address
First Line	:	125 EMERYVILLE DR STE 230
Second Line	:
City	:	CRANBERRY TWP
State	:	PA
Zip	:	16066-5020
Country	:	US
Telephone Number	:	724-609-5002
Fax Number	:	724-299-8964

Provider Business Practice Location Address
First Line	:	125 EMERYVILLE DR STE 230
Second Line	:
City	:	CRANBERRY TWP
State	:	PA
Zip	:	16066-5020
Country	:	US
Telephone Number	:	724-609-5002
Fax Number	:	724-299-8964

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

Provider Enumeration Date	:	10/28/2009
Last Update Date	:	03/15/2024

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