Provider Demographics
NPI:1407435795
Name:BRIDGES, KRISTAN LESLIE (LMSW)
Entity Type:Individual
Prefix:
First Name:KRISTAN
Middle Name:LESLIE
Last Name:BRIDGES
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 PRIOR CT
Mailing Address - Street 2:
Mailing Address - City:PALISADES
Mailing Address - State:NY
Mailing Address - Zip Code:10964-1516
Mailing Address - Country:US
Mailing Address - Phone:914-720-6500
Mailing Address - Fax:
Practice Address - Street 1:20 SQUADRON BLVD STE 550
Practice Address - Street 2:
Practice Address - City:NEW CITY
Practice Address - State:NY
Practice Address - Zip Code:10956-5272
Practice Address - Country:US
Practice Address - Phone:917-597-9270
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-05
Last Update Date:2021-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY112328-01104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker