Provider Demographics
NPI:1174388706
Name:HAILEY, BRIANA (LCSW)
Entity type:Individual
Prefix:
First Name:BRIANA
Middle Name:
Last Name:HAILEY
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 1:2 OAKVIEW DR
Mailing Address - Street 2:
Mailing Address - City:CAPE ELIZABETH
Mailing Address - State:ME
Mailing Address - Zip Code:04107-1129
Mailing Address - Country:US
Mailing Address - Phone:207-320-3547
Mailing Address - Fax:
Practice Address - Street 1:1 HARNOIS AVE STE 2A
Practice Address - Street 2:
Practice Address - City:WESTBROOK
Practice Address - State:ME
Practice Address - Zip Code:04092-4395
Practice Address - Country:US
Practice Address - Phone:207-661-3400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-13
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC229571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical