Provider Demographics
NPI:1790008407
Name:BAY RIDGE SERVICES INC
Entity Type:Organization
Organization Name:BAY RIDGE SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-648-0705
Mailing Address - Street 1:2781 OCEAN AVE
Mailing Address - Street 2:SUITE BB
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-4749
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2781 OCEAN AVE
Practice Address - Street 2:SUITE BB
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-4749
Practice Address - Country:US
Practice Address - Phone:718-648-0705
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-09
Last Update Date:2010-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty