Provider Demographics
NPI:1558917856
Name:DEFALCO, BRIDGET J (MA, CAADC)
Entity Type:Individual
Prefix:
First Name:BRIDGET
Middle Name:J
Last Name:DEFALCO
Suffix:
Gender:F
Credentials:MA, CAADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:944 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:FREELAND
Mailing Address - State:PA
Mailing Address - Zip Code:18224-1429
Mailing Address - Country:US
Mailing Address - Phone:570-436-7879
Mailing Address - Fax:
Practice Address - Street 1:944 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:FREELAND
Practice Address - State:PA
Practice Address - Zip Code:18224-1429
Practice Address - Country:US
Practice Address - Phone:570-436-7879
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-13
Last Update Date:2019-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty