Provider Demographics
NPI:1407133374
Name:TREMBLAY, BRIDGET (PSYD)
Entity Type:Individual
Prefix:DR
First Name:BRIDGET
Middle Name:
Last Name:TREMBLAY
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:904 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04103-2733
Mailing Address - Country:US
Mailing Address - Phone:617-320-8954
Mailing Address - Fax:
Practice Address - Street 1:500 FOREST AVE.
Practice Address - Street 2:SUITE 1A
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04101
Practice Address - Country:US
Practice Address - Phone:617-320-8954
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA77397106H00000X
ME4701106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist