Provider Demographics
NPI:1255663365
Name:UPPER BAY COUNSELING AND SUPPORT SERVICES, INC
Entity Type:Organization
Organization Name:UPPER BAY COUNSELING AND SUPPORT SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:RICH
Authorized Official - Middle Name:
Authorized Official - Last Name:BAYER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:410-996-5104
Mailing Address - Street 1:200 BOOTH ST
Mailing Address - Street 2:
Mailing Address - City:ELKTON
Mailing Address - State:MD
Mailing Address - Zip Code:21921-5657
Mailing Address - Country:US
Mailing Address - Phone:410-996-5104
Mailing Address - Fax:410-996-5197
Practice Address - Street 1:200 BOOTH ST
Practice Address - Street 2:
Practice Address - City:ELKTON
Practice Address - State:MD
Practice Address - Zip Code:21921-5657
Practice Address - Country:US
Practice Address - Phone:410-996-5104
Practice Address - Fax:410-996-5197
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-01
Last Update Date:2010-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD922500500Medicaid