Provider Demographics
NPI:1114420957
Name:RIVER BAY BEHAVIORAL HEALTH
Entity Type:Organization
Organization Name:RIVER BAY BEHAVIORAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:BRUCE
Authorized Official - Last Name:MINTEER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-C
Authorized Official - Phone:443-775-0126
Mailing Address - Street 1:101 LOG CANOE CIR STE F
Mailing Address - Street 2:
Mailing Address - City:STEVENSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21666-2106
Mailing Address - Country:US
Mailing Address - Phone:443-775-0126
Mailing Address - Fax:
Practice Address - Street 1:101 LOG CANOE CIR STE F
Practice Address - Street 2:
Practice Address - City:STEVENSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21666-2106
Practice Address - Country:US
Practice Address - Phone:443-775-0126
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-16
Last Update Date:2018-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD202211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty