Provider Demographics
NPI:1104680172
Name:BAILLY, ANAIS (LCSW)
Entity type:Individual
Prefix:
First Name:ANAIS
Middle Name:
Last Name:BAILLY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:ANAIS
Other - Middle Name:
Other - Last Name:BAILLY-MOMPOINT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:607 WALDEN WAY
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08048-4630
Mailing Address - Country:US
Mailing Address - Phone:640-223-0993
Mailing Address - Fax:
Practice Address - Street 1:607 WALDEN WAY
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:NJ
Practice Address - Zip Code:08048-4630
Practice Address - Country:US
Practice Address - Phone:640-223-0993
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-09
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0959661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical