Individual
ALYZA D BAILEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
1500 ROUTE 112 BLDG 4, SUITE101, PORT JEFFERSON STATION, NY 11776
(631) 574-8354
Mailing address
31 SPARROW DR, CORAM, NY 11727-2715
(631) 707-3897
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
096940
NY
1041C0700X
Clinical Social Worker
Primary
094350
NY
Other
Enumeration date
05/30/2019
Last updated
06/05/2025
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