Provider Demographics
NPI:1013031566
Name:BRIDGE COUNSELING SERVICES
Entity Type:Organization
Organization Name:BRIDGE COUNSELING SERVICES
Other - Org Name:BRIDGE WELLNESS CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:LYNNE
Authorized Official - Last Name:MCGARVEY
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:609-840-6034
Mailing Address - Street 1:507 ROUTE US 9 S
Mailing Address - Street 2:
Mailing Address - City:MARMORA
Mailing Address - State:NJ
Mailing Address - Zip Code:08223-1258
Mailing Address - Country:US
Mailing Address - Phone:609-840-6034
Mailing Address - Fax:609-840-6213
Practice Address - Street 1:507 ROUTE US 9 S
Practice Address - Street 2:
Practice Address - City:MARMORA
Practice Address - State:NJ
Practice Address - Zip Code:08223-1258
Practice Address - Country:US
Practice Address - Phone:609-840-6034
Practice Address - Fax:609-840-6213
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2022-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00200400101Y00000X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0020168Medicaid