Provider Demographics
NPI:1063736478
Name:BAILEY, PAOLA MARIA (PSYD)
Entity type:Individual
Prefix:DR
First Name:PAOLA
Middle Name:MARIA
Last Name:BAILEY
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3004 JEWEL ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90026-2809
Mailing Address - Country:US
Mailing Address - Phone:646-675-8449
Mailing Address - Fax:
Practice Address - Street 1:715 N CENTRAL AVE STE 108
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91203-1225
Practice Address - Country:US
Practice Address - Phone:310-341-0317
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-15
Last Update Date:2012-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018853-1103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical