Provider Demographics
NPI:1669585444
Name:BAY AREA PSYCHOLOGICAL CARE, INC.
Entity type:Organization
Organization Name:BAY AREA PSYCHOLOGICAL CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/LICENSED PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:MARI
Authorized Official - Last Name:PETRICA
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:727-771-6339
Mailing Address - Street 1:PO BOX 242
Mailing Address - Street 2:
Mailing Address - City:OLDSMAR
Mailing Address - State:FL
Mailing Address - Zip Code:34677-0242
Mailing Address - Country:US
Mailing Address - Phone:727-771-6339
Mailing Address - Fax:727-771-6338
Practice Address - Street 1:3780 TAMPA RD
Practice Address - Street 2:SUITE 115
Practice Address - City:OLDSMAR
Practice Address - State:FL
Practice Address - Zip Code:34677-3041
Practice Address - Country:US
Practice Address - Phone:727-771-6339
Practice Address - Fax:727-771-6338
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY5976103TC0700X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL54612OtherBLUE CROSS/BLUE SHIELD
FL179953Medicaid
FL179953Medicaid
FL54612OtherBLUE CROSS/BLUE SHIELD