Provider Demographics
NPI:1932292240
Name:BAY PSYCHOLOGICAL ASSOCIATES PC
Entity Type:Organization
Organization Name:BAY PSYCHOLOGICAL ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RITA
Authorized Official - Middle Name:MAE
Authorized Official - Last Name:SIERAKOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:MALLP
Authorized Official - Phone:989-686-1990
Mailing Address - Street 1:3941 TRAXLER COURT
Mailing Address - Street 2:SUITE 300
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48706
Mailing Address - Country:US
Mailing Address - Phone:989-686-1990
Mailing Address - Fax:989-686-0474
Practice Address - Street 1:3941 TRAXLER COURT
Practice Address - Street 2:SUITE 300
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48706
Practice Address - Country:US
Practice Address - Phone:989-686-1990
Practice Address - Fax:989-686-0474
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2011-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
6401006762101YP2500X
6401001984101YP2500X
6301002384103T00000X
6301007950103T00000X
6301009280103T00000X
6301003403103T00000X
6801071978104100000X
6801064601104100000X
43010350102084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
4438960OtherAETNA
7509105610OtherBCBSM
7509105610OtherFEDERAL BLUE CROSS
7509105610OtherBCBSM
0P19450Medicare ID - Type Unspecified