Provider Demographics
NPI:1093566705
Name:BRIDGES, TERESA LYSHA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:TERESA
Middle Name:LYSHA
Last Name:BRIDGES
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2139 N UNIVERSITY DR # 5308
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33071-6134
Mailing Address - Country:US
Mailing Address - Phone:786-488-7233
Mailing Address - Fax:
Practice Address - Street 1:8400 NW 36TH ST
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065-4503
Practice Address - Country:US
Practice Address - Phone:786-488-7233
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-29
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW22617101YM0800X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health