Provider Demographics
NPI:1073033460
Name:HINES, BRIDGET BREANNE (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:BRIDGET
Middle Name:BREANNE
Last Name:HINES
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:BRIDGET
Other - Middle Name:BREANNE
Other - Last Name:MARVIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSW, LCSW
Mailing Address - Street 1:15773 85TH PL N
Mailing Address - Street 2:
Mailing Address - City:MAPLE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55311-1568
Mailing Address - Country:US
Mailing Address - Phone:727-470-8683
Mailing Address - Fax:
Practice Address - Street 1:426 PHOENIX DR
Practice Address - Street 2:
Practice Address - City:CHAMBERSBURG
Practice Address - State:PA
Practice Address - Zip Code:17201-4537
Practice Address - Country:US
Practice Address - Phone:717-375-4834
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-27
Last Update Date:2017-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0193601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical