Healthcare Provider Details

I. General information

NPI: 1659894566
Provider Name (Legal Business Name): BAY RIDGE MENTAL HEALTH SERVICES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

575 BAY RIDGE PKWY
BROOKLYN NY
11209-3309
US

IV. Provider business mailing address

575 BAY RIDGE PKWY
BROOKLYN NY
11209-3309
US

V. Phone/Fax

Practice location:
  • Phone: 718-833-2094
  • Fax: 718-833-2094
Mailing address:
  • Phone: 718-833-2094
  • Fax: 718-833-2094

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number010645-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number020854-1
License Number StateNY

VIII. Authorized Official

Name: DR. FRANK CONFORTI
Title or Position: DIRECTOR
Credential: PSYD
Phone: 718-833-2094