Provider Demographics
NPI:1306214960
Name:BAINBRIDGE HOUSE, LLC
Entity Type:Organization
Organization Name:BAINBRIDGE HOUSE, LLC
Other - Org Name:BAINBRIDGE HOUSE COUNSELING SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MARA
Authorized Official - Middle Name:
Authorized Official - Last Name:OLIVA
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC, LMHC
Authorized Official - Phone:201-919-6184
Mailing Address - Street 1:200 PASSAIC ST
Mailing Address - Street 2:
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-3525
Mailing Address - Country:US
Mailing Address - Phone:551-800-7101
Mailing Address - Fax:
Practice Address - Street 1:200 PASSAIC ST
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-3525
Practice Address - Country:US
Practice Address - Phone:551-800-7101
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-11
Last Update Date:2015-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00526200261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)