Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC2200X | Clinical Child & Adolescent Psychologist | SS0000519 | FL |
N | 103TS0200X | School Psychologist | SS0000519 | FL |
N | 2084N0402X | Child Neurologist | SS0000519 | FL |
NPI | 1245241769 |
---|---|
Provider Name | Dr. Laura L. Bailet |
First Address | Rockland, DE 19732-0191 |
Second Address | Jacksonville, FL 32207-8426 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/08/2006 |
Last Update Date | 03/09/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000634554A | (05) | GA |