Provider Demographics
NPI:1346622214
Name:BAY CENTER THERAPY
Entity Type:Organization
Organization Name:BAY CENTER THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DEIRDRE
Authorized Official - Middle Name:
Authorized Official - Last Name:RADOSEVICH
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:920-430-0736
Mailing Address - Street 1:3336 COTTAGE HILL DR
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54311-6139
Mailing Address - Country:US
Mailing Address - Phone:740-972-1075
Mailing Address - Fax:
Practice Address - Street 1:5317 W GRANDE MARKET DR STE F7
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54913-8465
Practice Address - Country:US
Practice Address - Phone:920-430-0736
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-26
Last Update Date:2018-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty