Jeremy David Bailey, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

102807 Issued in CA

Practice address

120 D St
Santa Rosa, CA 95404-4732

Phone

(707) 360-0977

Fax

(510) 756-0812

NPI assigned

Feb 4, 2016

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1454544000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1638144000000",
    "number": "1184082109",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "781 HOEN CT",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954056720",
            "telephone_number": "415-336-8935"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "120 D ST",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954044732",
            "telephone_number": "707-360-0977",
            "fax_number": "510-756-0812"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BAILEY",
        "first_name": "JEREMY",
        "middle_name": "DAVID",
        "name_prefix": "Mr.",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2016-02-04",
        "last_updated": "2021-11-29",
        "certification_date": "2021-11-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "102807",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Runalia Bahar, M.D.
• Lia Marie Bahls, PMHNP-BC
• Harold Joseph Bahr
• Nazneen Bahrassa, PH.D.
• James Andrew Bailey, MA, MFT
• Mitchell Edward Bailey, M.D.
• Ojaya Bailey
• Gregory William Baird, DDS
• Jessica Baisley
• Agata Baker

• Clinical Social Worker in Santa Rosa, CA
• Providers in Santa Rosa, CA by specialty
• Clinical Social Worker in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 29, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.