Provider Demographics
NPI:1124282371
Name:BAYSIDE THERAPY, PC
Entity type:Organization
Organization Name:BAYSIDE THERAPY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:KIMBERLY
Authorized Official - Last Name:KESLER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LCPC
Authorized Official - Phone:301-399-4696
Mailing Address - Street 1:PO BOX 762
Mailing Address - Street 2:
Mailing Address - City:NORTH BEACH
Mailing Address - State:MD
Mailing Address - Zip Code:20714-0762
Mailing Address - Country:US
Mailing Address - Phone:301-399-4696
Mailing Address - Fax:410-741-3047
Practice Address - Street 1:8835 CHESAPEAKE AVENUE
Practice Address - Street 2:
Practice Address - City:NORTH BEACH
Practice Address - State:MD
Practice Address - Zip Code:20714
Practice Address - Country:US
Practice Address - Phone:301-399-4696
Practice Address - Fax:410-741-3047
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-17
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD2600101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty