Provider Demographics
NPI:1285090894
Name:BAYLISS, DONNA (MA)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:
Last Name:BAYLISS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 W CHESTER PIKE
Mailing Address - Street 2:SUITE 314
Mailing Address - City:HAVERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19083-4500
Mailing Address - Country:US
Mailing Address - Phone:610-449-4004
Mailing Address - Fax:610-449-4006
Practice Address - Street 1:525 W CHESTER PIKE
Practice Address - Street 2:SUITE 314
Practice Address - City:HAVERTOWN
Practice Address - State:PA
Practice Address - Zip Code:19083-4500
Practice Address - Country:US
Practice Address - Phone:610-449-4004
Practice Address - Fax:610-449-4006
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-12
Last Update Date:2016-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor