Provider Demographics
NPI:1003597543
Name:SUMA, BRIDGET BARBARA (MPS, LCAT)
Entity Type:Individual
Prefix:
First Name:BRIDGET
Middle Name:BARBARA
Last Name:SUMA
Suffix:
Gender:F
Credentials:MPS, LCAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 PIERMONT AVE
Mailing Address - Street 2:
Mailing Address - City:NYACK
Mailing Address - State:NY
Mailing Address - Zip Code:10960-4512
Mailing Address - Country:US
Mailing Address - Phone:971-242-9635
Mailing Address - Fax:
Practice Address - Street 1:15 N MILL ST
Practice Address - Street 2:
Practice Address - City:NYACK
Practice Address - State:NY
Practice Address - Zip Code:10960-3015
Practice Address - Country:US
Practice Address - Phone:971-242-9635
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-27
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY00283221700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt TherapistGroup - Multi-Specialty