Provider Demographics
NPI:1265581367
Name:BAILEY, MELISSA G (LCSW)
Entity type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:G
Last Name:BAILEY
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 1:37 HILLSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08540-1403
Mailing Address - Country:US
Mailing Address - Phone:609-924-8128
Mailing Address - Fax:609-688-9896
Practice Address - Street 1:37 HILLSIDE AVE
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08540-1403
Practice Address - Country:US
Practice Address - Phone:609-924-8128
Practice Address - Fax:609-688-9896
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00027900101YA0400X
NJ44SC001971001041C0700X
NJ37FI00125300106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ767163Medicare ID - Type Unspecified