Provider Demographics
NPI:1235553249
Name:BRIDGE MENTAL HEALTH
Entity Type:Organization
Organization Name:BRIDGE MENTAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:HELEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:DEMETRIADES
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:732-701-8400
Mailing Address - Street 1:1617 BEAVER DAM ROAD
Mailing Address - Street 2:
Mailing Address - City:POINT PLEASANT
Mailing Address - State:NJ
Mailing Address - Zip Code:08742
Mailing Address - Country:US
Mailing Address - Phone:732-701-8400
Mailing Address - Fax:732-701-8419
Practice Address - Street 1:1617 BEAVER DAM ROAD
Practice Address - Street 2:
Practice Address - City:POINT PLEASANT
Practice Address - State:NJ
Practice Address - Zip Code:08742
Practice Address - Country:US
Practice Address - Phone:732-701-8400
Practice Address - Fax:732-701-8419
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-11
Last Update Date:2014-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ103T00000X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ056110Medicare UPIN