Provider Demographics
NPI:1356738603
Name:BAY AREA YOUTH SERVICES
Entity type:Organization
Organization Name:BAY AREA YOUTH SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF CLINICAL SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:
Authorized Official - Last Name:COHEN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:407-506-7316
Mailing Address - Street 1:PO BOX 1538
Mailing Address - Street 2:
Mailing Address - City:MANGO
Mailing Address - State:FL
Mailing Address - Zip Code:33550-1538
Mailing Address - Country:US
Mailing Address - Phone:813-372-0235
Mailing Address - Fax:
Practice Address - Street 1:3104 CHERRY PALM DR STE 201
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33619-8374
Practice Address - Country:US
Practice Address - Phone:813-372-0235
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-23
Last Update Date:2024-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty