NPIMap

Organization Active NPI

Bay Harbor Behavioral Associates Inc.

  • Mental Health Counselor
  • Saint Petersburg, FL
National Provider Identifier
1770891715
Registry record updated Sep 22, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
MH 3061 Issued in FL
Legal business name
BAY HARBOR BEHAVIORAL ASSOCIATES INC.
Practice address
930 Snell Isle Blvd NE
Saint Petersburg, FL 33704-3830
Phone
(727) 743-3483
Fax
(727) 896-7272
NPI assigned
Sep 23, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 22, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ms. Sara Gedajlovic, MA, LMHCNPI 1720362544
Title
Ceo
Phone
(727) 743-3483

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YM0800X MH 3061 FL Primary
Behavior AnalystGroup: 193200000X MULTI-SPECIALTY GROUP 103K00000X MH 3061 FL
Community/Behavioral Health Agency 251S00000X

Addresses

Primary practice location

930 Snell Isle Blvd NE
Saint Petersburg, FL 33704-3830

Mailing address

930 Snell Isle Blvd NE
Saint Petersburg, FL 33704-3830
Phone (727) 743-3483

Other identifiers 3

IdentifierTypeStateIssuer
761456096MedicaidFL
761456098MedicaidFL
761456000MedicaidFL

National Provider Directory

National Provider Directory
Tax ID family
Bay Harbor Behavior Associates Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1285200000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1316649600000",
    "number": "1770891715",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "930 SNELL ISLE BLVD NE",
            "city": "SAINT PETERSBURG",
            "state": "FL",
            "postal_code": "337043830",
            "telephone_number": "727-743-3483",
            "fax_number": "727-896-7272"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "930 SNELL ISLE BLVD NE",
            "city": "SAINT PETERSBURG",
            "state": "FL",
            "postal_code": "337043830",
            "telephone_number": "727-743-3483",
            "fax_number": "727-896-7272"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BAY HARBOR BEHAVIORAL ASSOCIATES INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-09-23",
        "last_updated": "2011-09-22",
        "status": "A",
        "authorized_official_last_name": "GEDAJLOVIC",
        "authorized_official_first_name": "SARA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "727-743-3483",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "MA, LMHC"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": "FL",
            "license": "MH 3061",
            "primary": true
        },
        {
            "code": "103K00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Behavior Analyst",
            "state": "FL",
            "license": "MH 3061",
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "761456096",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "761456098",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "761456000",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Petersburg, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 22, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.