Provider Demographics
NPI:1770891715
Name:BAY HARBOR BEHAVIORAL ASSOCIATES INC.
Entity type:Organization
Organization Name:BAY HARBOR BEHAVIORAL ASSOCIATES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:SARA
Authorized Official - Middle Name:
Authorized Official - Last Name:GEDAJLOVIC
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LMHC
Authorized Official - Phone:727-743-3483
Mailing Address - Street 1:930 SNELL ISLE BLVD NE
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33704-3830
Mailing Address - Country:US
Mailing Address - Phone:727-743-3483
Mailing Address - Fax:727-896-7272
Practice Address - Street 1:930 SNELL ISLE BLVD NE
Practice Address - Street 2:
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33704-3830
Practice Address - Country:US
Practice Address - Phone:727-743-3483
Practice Address - Fax:727-896-7272
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-23
Last Update Date:2011-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 3061103K00000X, 101YM0800X
251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL761456096Medicaid
FL761456098Medicaid
FL761456000Medicaid