Provider Demographics
NPI:1023367679
Name:HERREN, BRIDGETTE D (LISW, LICDC, MSW)
Entity Type:Individual
Prefix:
First Name:BRIDGETTE
Middle Name:D
Last Name:HERREN
Suffix:
Gender:F
Credentials:LISW, LICDC, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5818 WILMINGTON PIKE
Mailing Address - Street 2:PMB 207
Mailing Address - City:CENTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45459-7004
Mailing Address - Country:US
Mailing Address - Phone:937-301-5549
Mailing Address - Fax:
Practice Address - Street 1:7133 OLD TROY PIKE
Practice Address - Street 2:
Practice Address - City:HUBER HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:45424-2658
Practice Address - Country:US
Practice Address - Phone:937-301-5549
Practice Address - Fax:937-723-9095
Is Sole Proprietor?:No
Enumeration Date:2012-08-29
Last Update Date:2022-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHICDC.141066101YA0400X
I.16007051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)