Provider Demographics
NPI:1003201021
Name:BRIDWELL-PAUL, THOMIKA MARIE
Entity Type:Individual
Prefix:
First Name:THOMIKA
Middle Name:MARIE
Last Name:BRIDWELL-PAUL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 WAUMBECK ST
Mailing Address - Street 2:APT 2
Mailing Address - City:DORCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:02121-1220
Mailing Address - Country:US
Mailing Address - Phone:617-388-3307
Mailing Address - Fax:
Practice Address - Street 1:21 WAUMBECK ST
Practice Address - Street 2:APT 2
Practice Address - City:DORCHESTER
Practice Address - State:MA
Practice Address - Zip Code:02121-1220
Practice Address - Country:US
Practice Address - Phone:617-388-3307
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-06
Last Update Date:2015-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor