Provider Demographics
NPI:1073616678
Name:BRIDGE COUNSELING AND THERAPY CENTER, LLC
Entity Type:Organization
Organization Name:BRIDGE COUNSELING AND THERAPY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:VANINI
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:302-856-9190
Mailing Address - Street 1:32 BRIDGEVILLE RD
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:DE
Mailing Address - Zip Code:19947-2106
Mailing Address - Country:US
Mailing Address - Phone:302-856-9190
Mailing Address - Fax:302-856-9133
Practice Address - Street 1:32 BRIDGEVILLE RD
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:DE
Practice Address - Zip Code:19947-2106
Practice Address - Country:US
Practice Address - Phone:302-856-9190
Practice Address - Fax:302-856-9133
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-07
Last Update Date:2008-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEQ1000002811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1000032299Medicaid
DE1000032299Medicaid