Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker | S0500353 | OH |
NPI | 1003383548 |
---|---|
Provider Name | Andrea Bailey |
First Address | Youngstown, OH 44511-1947 |
Second Address | Niles, OH 44446-2352 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/11/2018 |
Last Update Date | 01/11/2018 |