MEDICARE: BAY AREA YOUTH SERVICES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1356738603
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BAY AREA YOUTH SERVICES

Provider Business Mailing Address
First Line	:	PO BOX 1538
Second Line	:
City	:	MANGO
State	:	FL
Zip	:	33550-1538
Country	:	US
Telephone Number	:	813-372-0235
Fax Number	:

Provider Business Practice Location Address
First Line	:	3104 CHERRY PALM DR STE 201
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33619-8374
Country	:	US
Telephone Number	:	813-372-0235
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR OF CLINICAL SERVICES
Name	:	ADAM COHEN
Credential	:	LCSW
Telephone Number	:	407-506-7316

Provider Enumeration Date	:	04/23/2015
Last Update Date	:	08/10/2024

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Directions to “BAY AREA YOUTH SERVICES ” Practice Location

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