Provider Demographics
NPI:1528603362
Name:GONZALEZ, BRIDGET CELESTE
Entity Type:Individual
Prefix:MRS
First Name:BRIDGET
Middle Name:CELESTE
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:324 N CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07090-2413
Mailing Address - Country:US
Mailing Address - Phone:917-747-4052
Mailing Address - Fax:
Practice Address - Street 1:324 N CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07090-2413
Practice Address - Country:US
Practice Address - Phone:917-747-4052
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-15
Last Update Date:2019-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ103K00000XOtherSPECIAL SERVICES