Provider Demographics
NPI:1164782488
Name:BRIDGE TO CHANGE LLC
Entity Type:Organization
Organization Name:BRIDGE TO CHANGE LLC
Other - Org Name:KAREN LOONEY-MASTERSON MA, CAMF
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR/OWNER/COUNSELOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:LOONEY-MASTERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CAMF
Authorized Official - Phone:908-246-4011
Mailing Address - Street 1:470 SCHOOLEY'S MOUNTAIN ROAD
Mailing Address - Street 2:HASTINGS SQUARE SUITE 10
Mailing Address - City:HACKETTSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07840
Mailing Address - Country:US
Mailing Address - Phone:908-246-4011
Mailing Address - Fax:
Practice Address - Street 1:470 SCHOOLEY'S MOUNTAIN ROAD
Practice Address - Street 2:HASTINGS SQUARE SUITE 10
Practice Address - City:HACKETTSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07840
Practice Address - Country:US
Practice Address - Phone:908-246-4011
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-21
Last Update Date:2012-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty