Provider Demographics
NPI:1568861185
Name:BAY AREA BEHAVIORAL CONNECTION
Entity Type:Organization
Organization Name:BAY AREA BEHAVIORAL CONNECTION
Other - Org Name:BAY AREA BEHAVIORAL CONNECTION
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JESSE
Authorized Official - Middle Name:THI
Authorized Official - Last Name:LAM
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:408-605-6280
Mailing Address - Street 1:4423 FORTRAN CT
Mailing Address - Street 2:SUITE 136
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95134-2316
Mailing Address - Country:US
Mailing Address - Phone:408-605-6280
Mailing Address - Fax:408-586-8654
Practice Address - Street 1:4423 FORTRAN CT
Practice Address - Street 2:SUITE 136
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95134-2316
Practice Address - Country:US
Practice Address - Phone:408-605-6280
Practice Address - Fax:408-586-8654
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-20
Last Update Date:2014-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health