Provider Demographics
NPI:1467756569
Name:LENNON, BRIDGET (PMHNP)
Entity Type:Individual
Prefix:
First Name:BRIDGET
Middle Name:
Last Name:LENNON
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:242 MAIN ST # 317
Mailing Address - Street 2:
Mailing Address - City:BEACON
Mailing Address - State:NY
Mailing Address - Zip Code:12508-2732
Mailing Address - Country:US
Mailing Address - Phone:212-801-2082
Mailing Address - Fax:914-371-3847
Practice Address - Street 1:239 N BROADWAY STE 6
Practice Address - Street 2:
Practice Address - City:SLEEPY HOLLOW
Practice Address - State:NY
Practice Address - Zip Code:10591-2654
Practice Address - Country:US
Practice Address - Phone:212-801-2082
Practice Address - Fax:888-706-1331
Is Sole Proprietor?:No
Enumeration Date:2011-01-04
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY402805363LP0808X, 364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health