Provider Demographics
NPI:1053821819
Name:BAY AREA MEDIATIONS
Entity Type:Organization
Organization Name:BAY AREA MEDIATIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGE
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:M
Authorized Official - Last Name:ESCUDIE
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:813-546-4027
Mailing Address - Street 1:15310 AMBERLY DRIVE
Mailing Address - Street 2:SUITE 250
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647-2199
Mailing Address - Country:US
Mailing Address - Phone:813-546-4027
Mailing Address - Fax:
Practice Address - Street 1:15310 AMBERLY DR
Practice Address - Street 2:SUITE 250
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33647-2199
Practice Address - Country:US
Practice Address - Phone:813-546-4027
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-06
Last Update Date:2017-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH11422101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty