Provider Demographics
NPI:1780753657
Name:BAILEY, MARY CATHERINE (LCSW)
Entity type:Individual
Prefix:
First Name:MARY CATHERINE
Middle Name:
Last Name:BAILEY
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 1:20070 BARLETTA LN UNIT 126
Mailing Address - Street 2:
Mailing Address - City:ESTERO
Mailing Address - State:FL
Mailing Address - Zip Code:33928-6326
Mailing Address - Country:US
Mailing Address - Phone:845-653-1289
Mailing Address - Fax:
Practice Address - Street 1:418 BROADWAY # 5753
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12207-2922
Practice Address - Country:US
Practice Address - Phone:845-653-1289
Practice Address - Fax:845-364-9422
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2024-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR029325103T00000X
RO293251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN7A983Medicare ID - Type Unspecified