Provider Demographics
NPI:1053798702
Name:BAILLIO PSYCHOLOGICAL SERVICES, PA
Entity type:Organization
Organization Name:BAILLIO PSYCHOLOGICAL SERVICES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JILL
Authorized Official - Middle Name:N
Authorized Official - Last Name:BAILLIO
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:813-294-0577
Mailing Address - Street 1:4081 BEACH DR SE
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33705-4125
Mailing Address - Country:US
Mailing Address - Phone:813-294-0577
Mailing Address - Fax:
Practice Address - Street 1:735 ARLINGTON AVE N
Practice Address - Street 2:SUITE 205
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701-3652
Practice Address - Country:US
Practice Address - Phone:813-294-0577
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-01
Last Update Date:2016-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY8287103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty