Provider Demographics
NPI:1689173759
Name:BAY PSYCHOLOGY GROUP INC
Entity Type:Organization
Organization Name:BAY PSYCHOLOGY GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:S
Authorized Official - Last Name:SEDGELEY
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:510-788-0005
Mailing Address - Street 1:4900 SHATTUCK AVE UNIT 3593
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609-7022
Mailing Address - Country:US
Mailing Address - Phone:510-788-0005
Mailing Address - Fax:
Practice Address - Street 1:4900 SHATTUCK AVE UNIT 3593
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-7022
Practice Address - Country:US
Practice Address - Phone:510-788-0005
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-05
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY27612103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty