Provider Demographics
NPI:1033567987
Name:CHRISTOFORATOS, BRIDIE (LMSW)
Entity Type:Individual
Prefix:MS
First Name:BRIDIE
Middle Name:
Last Name:CHRISTOFORATOS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 MONTROSE LN
Mailing Address - Street 2:
Mailing Address - City:EAST NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11731-1337
Mailing Address - Country:US
Mailing Address - Phone:516-512-1348
Mailing Address - Fax:
Practice Address - Street 1:14 MONTROSE LN
Practice Address - Street 2:
Practice Address - City:EAST NORTHPORT
Practice Address - State:NY
Practice Address - Zip Code:11731-1337
Practice Address - Country:US
Practice Address - Phone:516-512-1348
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-01
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY094135104100000X
NY094135-1102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst