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NPI Code Detail

MEDICARE: LITA RENEE BAILEY MSW

MEDICARE:   LITA RENEE BAILEY  MSW
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
1101YM0800XMental Health CounselorMA

General Provider Information

NPI Number : 1154964070
Entity Type Code : Individual
Provider Name (Legal Business Name) : LITA RENEE BAILEY MSW
Provider Business Mailing Address
First Line : 21 RADCLIFFE RD
Second Line :
City : HYDE PARK
State : MA
Zip : 02136-6112
Country : US
Telephone Number : 617-233-2641
Fax Number :
Provider Business Practice Location Address
First Line : 21 RADCLIFFE RD
Second Line :
City : HYDE PARK
State : MA
Zip : 02136-6112
Country : US
Telephone Number : 617-233-2641
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/23/2019
Last Update Date : 10/23/2019

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