Provider Demographics
NPI:1578594271
Name:MCVAN, BRIDGET TARA (PHD, LPC)
Entity Type:Individual
Prefix:DR
First Name:BRIDGET
Middle Name:TARA
Last Name:MCVAN
Suffix:
Gender:F
Credentials:PHD, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1507 ELLIOT AVE
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18018-4719
Mailing Address - Country:US
Mailing Address - Phone:610-866-2313
Mailing Address - Fax:
Practice Address - Street 1:1507 ELLIOT AVE
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18018-4719
Practice Address - Country:US
Practice Address - Phone:610-866-2313
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC003771101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional