Provider Demographics
NPI:1679589535
Name:BAILEY, CANDACE KAY (MSW LCSW)
Entity type:Individual
Prefix:MRS
First Name:CANDACE
Middle Name:KAY
Last Name:BAILEY
Suffix:
Gender:F
Credentials:MSW LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6505 W SAGUARO DR
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85304-3636
Mailing Address - Country:US
Mailing Address - Phone:602-577-0788
Mailing Address - Fax:
Practice Address - Street 1:7163 N 58TH DR STE A
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85301-2480
Practice Address - Country:US
Practice Address - Phone:602-577-0788
Practice Address - Fax:623-535-9376
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW109681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ889347Medicaid