Provider Demographics
NPI:1174023386
Name:STANTON, BRIDGET R
Entity Type:Individual
Prefix:
First Name:BRIDGET
Middle Name:R
Last Name:STANTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4516 RIVER OVERLOOK DR
Mailing Address - Street 2:
Mailing Address - City:VALRICO
Mailing Address - State:FL
Mailing Address - Zip Code:33596-7825
Mailing Address - Country:US
Mailing Address - Phone:904-201-9774
Mailing Address - Fax:
Practice Address - Street 1:4516 RIVER OVERLOOK DR
Practice Address - Street 2:
Practice Address - City:VALRICO
Practice Address - State:FL
Practice Address - Zip Code:33596-7825
Practice Address - Country:US
Practice Address - Phone:904-201-9774
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-14
Last Update Date:2022-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH20533101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health