Provider Demographics
NPI:1518256114
Name:BRIDGEWATER, DEE ARTHUR (PHD)
Entity Type:Individual
Prefix:DR
First Name:DEE
Middle Name:ARTHUR
Last Name:BRIDGEWATER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 BROOKS AVE
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:CA
Mailing Address - Zip Code:90291-3254
Mailing Address - Country:US
Mailing Address - Phone:310-859-2336
Mailing Address - Fax:
Practice Address - Street 1:9100 WILSHIRE BLVD
Practice Address - Street 2:SUITE 844W
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90212-3415
Practice Address - Country:US
Practice Address - Phone:310-859-2336
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-04
Last Update Date:2011-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY11130103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist