Provider Demographics
NPI:1316762719
Name:VANANTWERP, BAILEE OLIVIA (LCSW)
Entity type:Individual
Prefix:
First Name:BAILEE
Middle Name:OLIVIA
Last Name:VANANTWERP
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7510 MONTGOMERY BLVD NE STE 202
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-1500
Mailing Address - Country:US
Mailing Address - Phone:505-933-1978
Mailing Address - Fax:
Practice Address - Street 1:4101 BARBARA LOOP SE STE C
Practice Address - Street 2:
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124-1011
Practice Address - Country:US
Practice Address - Phone:505-933-1978
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-20
Last Update Date:2025-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMSWB-2025-11601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMN0008167Medicaid