Provider Demographics
NPI:1730696527
Name:BAILEY, DOLORES MIRANDA (LICSW)
Entity type:Individual
Prefix:
First Name:DOLORES
Middle Name:MIRANDA
Last Name:BAILEY
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:142 PARKER ST
Mailing Address - Street 2:
Mailing Address - City:NORWELL
Mailing Address - State:MA
Mailing Address - Zip Code:02061-1425
Mailing Address - Country:US
Mailing Address - Phone:781-789-4705
Mailing Address - Fax:
Practice Address - Street 1:384 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:NORWELL
Practice Address - State:MA
Practice Address - Zip Code:02061-2010
Practice Address - Country:US
Practice Address - Phone:781-871-6550
Practice Address - Fax:781-982-3464
Is Sole Proprietor?:No
Enumeration Date:2018-01-03
Last Update Date:2018-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1049771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical