Provider Demographics
NPI:1508388836
Name:BRIDGMAN, LAIRD PATRICK (PSYD)
Entity Type:Individual
Prefix:DR
First Name:LAIRD
Middle Name:PATRICK
Last Name:BRIDGMAN
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22772 CENTRE DR STE 205
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:CA
Mailing Address - Zip Code:92630-6303
Mailing Address - Country:US
Mailing Address - Phone:949-636-2207
Mailing Address - Fax:949-770-5433
Practice Address - Street 1:22772 CENTRE DR STE 205
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:CA
Practice Address - Zip Code:92630-6303
Practice Address - Country:US
Practice Address - Phone:949-636-2207
Practice Address - Fax:949-770-5433
Is Sole Proprietor?:No
Enumeration Date:2017-07-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY14510103T00000X, 103TC0700X, 103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical