Individual
DR. LAURA L. BAILET
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
807 CHILDRENS WAY, JACKSONVILLE, FL 32207-8426
(904) 390-3780
(904) 390-3429
Mailing address
PO BOX 191, PROVIDER ENROLLMENT DEPT, ROCKLAND, DE 19732-0191
(302) 651-6212
(302) 651-4945
Taxonomy
Speciality
Code
Description
License number
State
103TC2200X
Clinical Child & Adolescent Psychologist
Primary
SS0000519
FL
103TS0200X
School Psychologist
SS0000519
FL
2084N0402X
Neurology with Special Qualifications in Child Neurology Physician
SS0000519
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000634554A
—
GA
Enumeration date
08/10/2006
Last updated
09/03/2011
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