Provider Demographics
NPI:1750757886
Name:BAILEY, DARENA ANN (PHD)
Entity type:Individual
Prefix:DR
First Name:DARENA
Middle Name:ANN
Last Name:BAILEY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13778 RUETTE LE PARC
Mailing Address - Street 2:SUITE E
Mailing Address - City:DEL MAR
Mailing Address - State:CA
Mailing Address - Zip Code:92014
Mailing Address - Country:US
Mailing Address - Phone:707-799-5412
Mailing Address - Fax:
Practice Address - Street 1:13778 RUETTE LE PARC
Practice Address - Street 2:SUITE E
Practice Address - City:DEL MAR
Practice Address - State:CA
Practice Address - Zip Code:92014
Practice Address - Country:US
Practice Address - Phone:707-799-5412
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-12
Last Update Date:2015-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4399103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist