Provider Demographics
NPI:1740572965
Name:PETEET, BRIDGETTE J (PHD)
Entity Type:Individual
Prefix:
First Name:BRIDGETTE
Middle Name:J
Last Name:PETEET
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:BRIDGETTE
Other - Middle Name:J
Other - Last Name:MITCHELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:11130 ANDERSON ST
Mailing Address - Street 2:
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92350-1729
Mailing Address - Country:US
Mailing Address - Phone:909-558-8717
Mailing Address - Fax:
Practice Address - Street 1:11130 ANDERSON ST
Practice Address - Street 2:
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92350-1729
Practice Address - Country:US
Practice Address - Phone:909-558-8717
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-05
Last Update Date:2020-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31726103TC0700X
OH6300103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical