Provider Demographics
NPI:1477008258
Name:BRIDGMAN, SHARI (PHD)
Entity Type:Individual
Prefix:DR
First Name:SHARI
Middle Name:
Last Name:BRIDGMAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22772 CENTRE DR
Mailing Address - Street 2:SUITE 205
Mailing Address - City:LAKE FOREST
Mailing Address - State:CA
Mailing Address - Zip Code:92630-6303
Mailing Address - Country:US
Mailing Address - Phone:949-581-8334
Mailing Address - Fax:
Practice Address - Street 1:22772 CENTRE DR
Practice Address - Street 2:SUITE 205
Practice Address - City:LAKE FOREST
Practice Address - State:CA
Practice Address - Zip Code:92630-6303
Practice Address - Country:US
Practice Address - Phone:949-581-8334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-22
Last Update Date:2016-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA28928106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist