Basic Information
| Provider Information | |||||||||
| NPI: | 1730696527 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BAILEY | ||||||||
| FirstName: | DOLORES | ||||||||
| MiddleName: | MIRANDA | ||||||||
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| Credential: | LICSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 142 PARKER ST | ||||||||
| Address2: | |||||||||
| City: | NORWELL | ||||||||
| State: | MA | ||||||||
| PostalCode: | 020611425 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7817894705 | ||||||||
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| Practice Location | |||||||||
| Address1: | 384 WASHINGTON ST | ||||||||
| Address2: | |||||||||
| City: | NORWELL | ||||||||
| State: | MA | ||||||||
| PostalCode: | 020612010 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7818716550 | ||||||||
| FaxNumber: | 7819823464 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/03/2018 | ||||||||
| LastUpdateDate: | 01/03/2018 | ||||||||
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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 | 1041C0700X | 104977 | MA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.