Provider Demographics
NPI:1578072559
Name:BROWNBRIDGE, MICHAEL BENJAMIN (MSW, LSW)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:BENJAMIN
Last Name:BROWNBRIDGE
Suffix:
Gender:M
Credentials:MSW, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1030 LORRAINE AVE
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083-7007
Mailing Address - Country:US
Mailing Address - Phone:609-271-9662
Mailing Address - Fax:
Practice Address - Street 1:6 CORNWALL CT STE B
Practice Address - Street 2:
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816-3347
Practice Address - Country:US
Practice Address - Phone:732-955-4141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-22
Last Update Date:2017-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL062901001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical