Provider Demographics
NPI:1902911332
Name:BAYLIS, TRICIA B (LCSW)
Entity Type:Individual
Prefix:MS
First Name:TRICIA
Middle Name:B
Last Name:BAYLIS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:73 S CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11580-5402
Mailing Address - Country:US
Mailing Address - Phone:516-872-9698
Mailing Address - Fax:516-872-8758
Practice Address - Street 1:73 S CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11580-5402
Practice Address - Country:US
Practice Address - Phone:516-872-9698
Practice Address - Fax:516-872-8758
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY071266-1101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00244817Medicaid
NY00244817Medicaid