Provider Demographics
NPI:1053440560
Name:GERAGHTY, BRIDGET MARY (MSW)
Entity Type:Individual
Prefix:MS
First Name:BRIDGET
Middle Name:MARY
Last Name:GERAGHTY
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:MS
Other - First Name:BRIDGET
Other - Middle Name:GERAGHTY
Other - Last Name:BARNICLE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSW
Mailing Address - Street 1:4919 NE 14TH PL
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97211-5025
Mailing Address - Country:US
Mailing Address - Phone:503-367-0882
Mailing Address - Fax:
Practice Address - Street 1:1500 NE IRVING ST
Practice Address - Street 2:SUITE 250
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-2243
Practice Address - Country:US
Practice Address - Phone:503-233-4356
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORA1882104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker