Provider Demographics
NPI:1386827293
Name:MEMORY BRIDGING INCORPORATED
Entity Type:Organization
Organization Name:MEMORY BRIDGING INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF ADMINISTRATION
Authorized Official - Prefix:
Authorized Official - First Name:SUSANNE
Authorized Official - Middle Name:E
Authorized Official - Last Name:BABER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-267-0030
Mailing Address - Street 1:141 MACK BAYOU LOOP
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SANTA ROSA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32459-7194
Mailing Address - Country:US
Mailing Address - Phone:850-267-0030
Mailing Address - Fax:850-267-0034
Practice Address - Street 1:16154 ROCK CRYSTAL DR
Practice Address - Street 2:
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80134-3305
Practice Address - Country:US
Practice Address - Phone:303-328-1195
Practice Address - Fax:303-557-6240
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-13
Last Update Date:2009-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO803103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Multi-Specialty