Provider Demographics
NPI:1699910539
Name:BAILEY, LISA LUCERO (LCSW)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:LUCERO
Last Name:BAILEY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1400
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72203-1400
Mailing Address - Country:US
Mailing Address - Phone:501-372-5039
Mailing Address - Fax:501-372-5529
Practice Address - Street 1:700 W 4TH ST
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72201-2204
Practice Address - Country:US
Practice Address - Phone:501-372-5039
Practice Address - Fax:501-372-5529
Is Sole Proprietor?:No
Enumeration Date:2008-12-05
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1816-M1041C0700X
AR2559-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical