Provider Demographics
NPI:1194025379
Name:SULLIVAN, BRIDGETT F (PC)
Entity Type:Individual
Prefix:
First Name:BRIDGETT
Middle Name:F
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 W 8TH ST
Mailing Address - Street 2:BUILDING A SUITE 200
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45203-1601
Mailing Address - Country:US
Mailing Address - Phone:859-525-3500
Mailing Address - Fax:859-525-3209
Practice Address - Street 1:8275 EWING BLVD
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042-7535
Practice Address - Country:US
Practice Address - Phone:859-525-3200
Practice Address - Fax:859-525-3209
Is Sole Proprietor?:No
Enumeration Date:2010-10-22
Last Update Date:2014-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE0007918101YP2500X
KYKY0469101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional