Provider Demographics
NPI:1316762719
Name:VANANTWERP, BAILEE OLIVIA (LMSW)
Entity type:Individual
Prefix:
First Name:BAILEE
Middle Name:OLIVIA
Last Name:VANANTWERP
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1020 6TH ST NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87102-2045
Mailing Address - Country:US
Mailing Address - Phone:217-781-3885
Mailing Address - Fax:
Practice Address - Street 1:9400 HOLLY AVE NE BLDG 4
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87122-2969
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:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMSWB-2024-0342104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker