Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | LC12560 | ME |
NPI | 1003172578 |
---|---|
Provider Name | Cynthia K Bailey |
First Address | Auburn, ME 04210-9302 |
Second Address | Lewiston, ME 04240-6578 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/04/2012 |
Last Update Date | 17/07/2019 |