Provider Demographics
NPI:1427566645
Name:BRIDGE OF LOVE II LLC
Entity Type:Organization
Organization Name:BRIDGE OF LOVE II LLC
Other - Org Name:BRIDGE OF LOVE II LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:BRIDGETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:MONTGOMERY
Authorized Official - Suffix:
Authorized Official - Credentials:DSW MSW LCSW MSNPM
Authorized Official - Phone:267-206-8762
Mailing Address - Street 1:18 CAMPUS BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:NEWTOWN SQUARE
Mailing Address - State:PA
Mailing Address - Zip Code:19073-3240
Mailing Address - Country:US
Mailing Address - Phone:484-423-3426
Mailing Address - Fax:484-423-3401
Practice Address - Street 1:331 MARGATE RD
Practice Address - Street 2:
Practice Address - City:UPPER DARBY
Practice Address - State:PA
Practice Address - Zip Code:19082-4613
Practice Address - Country:US
Practice Address - Phone:484-424-6629
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-22
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty