MEDICARE: LISA MARIE BAILEY LCSW

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	1041C0700X	Clinical Social Worker	LCSW-22273	AZ
2	1041C0700X	Clinical Social Worker	CSW.09926016	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CSW.09926016	OTHER	CO	LICENSED CLINICAL SOCIAL WORKER
2	13823	OTHER	LA	LOUSIANA STATE BOARD OF SOCIAL WORK EXAMINERS LMSW

General Provider Information

NPI Number	:	1447721345
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA MARIE BAILEY LCSW

Provider Business Mailing Address
First Line	:	197 E FRY BLVD
Second Line	:
City	:	SIERRA VISTA
State	:	AZ
Zip	:	85635-1847
Country	:	US
Telephone Number	:	520-508-9586
Fax Number	:

Provider Business Practice Location Address
First Line	:	197 E FRY BLVD
Second Line	:
City	:	SIERRA VISTA
State	:	AZ
Zip	:	85635-1847
Country	:	US
Telephone Number	:	520-508-9586
Fax Number	:

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

Provider Enumeration Date	:	12/17/2018
Last Update Date	:	11/24/2025

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Directions to “ LISA MARIE BAILEY LCSW” Practice Location

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