Provider Demographics
NPI:1962992453
Name:BAILER, JOHN TREVOR (LCSW)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:TREVOR
Last Name:BAILER
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:TREVOR
Other - Middle Name:
Other - Last Name:BAILER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2230 ROUTE 70 W # 1033
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08002-3338
Mailing Address - Country:US
Mailing Address - Phone:610-931-2972
Mailing Address - Fax:
Practice Address - Street 1:2230 ROUTE 70 W # 1033
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08002-3338
Practice Address - Country:US
Practice Address - Phone:610-931-2972
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-10
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC059802001041C0700X
PASW134345104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker