Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 4349 | NJ |
Y | 103T00000X | Psychologist | 4349 | NJ |
N | 103TB0200X | Cognitive & Behavioral Psychologist | 4349 | NJ |
N | 103G00000X | Clinical Psychologist | 4349 | NJ |
N | 103TC0700X | Clinical Psychologist | 4349 | NJ |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | 4349 | NJ |
N | 103TF0000X | Family Psychologist | 4349 | NJ |
N | 103TP2701X | Group Psychotherapist | 4349 | NJ |
N | 103TS0200X | School Psychologist | 4349 | NJ |
NPI | 1215145016 |
---|---|
Provider Name | Dr. David Alex Bailey |
First Address | Beachwood, OH 44122-5535 |
Second Address | Beachwood, OH 44122-1580 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/05/2007 |
Last Update Date | 26/10/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
7271 | PSYCHOLOGY LICENSE (01) | OH |