Healthcare Provider Details

I. General information

NPI: 1154275535
Provider Name (Legal Business Name): BAYSIDE BEHAVIORAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2026
Last Update Date: 02/23/2026
Certification Date: 02/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4690 MILLENNIUM DR STE 300
BELCAMP MD
21017-1527
US

IV. Provider business mailing address

4690 MILLENNIUM DR STE 300
BELCAMP MD
21017-1527
US

V. Phone/Fax

Practice location:
  • Phone: 443-267-7553
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: AMANDA EBLIN
Title or Position: PMHNP
Credential:
Phone: 443-267-7553