MEDICARE: MS. KAREN D BAILEY LMSW

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	104100000X	Social Worker	036201-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	036201-1	OTHER	NY	NEW YORK STATE

General Provider Information

NPI Number	:	1518109107
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KAREN D BAILEY LMSW

Provider Business Mailing Address
First Line	:	171 IRVING ST
Second Line	:
City	:	LOCKPORT
State	:	NY
Zip	:	14094-2543
Country	:	US
Telephone Number	:	716-297-0798
Fax Number	:	716-297-0998

Provider Business Practice Location Address
First Line	:	171 IRVING ST
Second Line	:
City	:	LOCKPORT
State	:	NY
Zip	:	14094-2543
Country	:	US
Telephone Number	:	716-297-0798
Fax Number	:	716-297-0998

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

Provider Enumeration Date	:	03/30/2009
Last Update Date	:	03/30/2009

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