Provider Demographics
NPI:1932816980
Name:BAYBERRY PSYCHOLOGY & CONSULTING LLC
Entity Type:Organization
Organization Name:BAYBERRY PSYCHOLOGY & CONSULTING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:S
Authorized Official - Last Name:MCCANN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:901-490-9700
Mailing Address - Street 1:9 APPIAN WAY
Mailing Address - Street 2:
Mailing Address - City:BARRINGTON
Mailing Address - State:RI
Mailing Address - Zip Code:02806-1821
Mailing Address - Country:US
Mailing Address - Phone:901-490-9700
Mailing Address - Fax:
Practice Address - Street 1:291 WATERMAN ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02906-5130
Practice Address - Country:US
Practice Address - Phone:401-426-4239
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-31
Last Update Date:2022-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)