Basic Information
| Provider Information | |||||||||
| NPI: | 1629010608 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BAILEY | ||||||||
| FirstName: | CAROL | ||||||||
| MiddleName: | MCCARTY | ||||||||
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| Credential: | L.S.W. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1123 UPPER RAVEN CREEK RD | ||||||||
| Address2: | |||||||||
| City: | BENTON | ||||||||
| State: | PA | ||||||||
| PostalCode: | 178147759 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5704411162 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 435 W 4TH ST | ||||||||
| Address2: | |||||||||
| City: | WILLIAMSPORT | ||||||||
| State: | PA | ||||||||
| PostalCode: | 177016001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5703227873 | ||||||||
| FaxNumber: | 5703228026 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/12/2006 | ||||||||
| LastUpdateDate: | 02/08/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | SW-123224 | PA | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.