Provider Demographics
NPI:1639637432
Name:BAYSIDE PSYCHOLOGY AND CONSULTING, LLC
Entity Type:Organization
Organization Name:BAYSIDE PSYCHOLOGY AND CONSULTING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARSHALL
Authorized Official - Middle Name:J
Authorized Official - Last Name:ROBINSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:207-464-4080
Mailing Address - Street 1:1 UNION ST STE 402
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04101-4048
Mailing Address - Country:US
Mailing Address - Phone:207-464-4080
Mailing Address - Fax:207-850-2116
Practice Address - Street 1:1 UNION ST STE 402
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04101-4048
Practice Address - Country:US
Practice Address - Phone:207-464-4080
Practice Address - Fax:207-850-2116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-11
Last Update Date:2019-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty