Provider Demographics
NPI:1760001143
Name:BRIDGES COUNSELING CENTER FOR CHILD & FAMILY WELLNESS AT BEDMINSTER
Entity Type:Organization
Organization Name:BRIDGES COUNSELING CENTER FOR CHILD & FAMILY WELLNESS AT BEDMINSTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECOTR
Authorized Official - Prefix:MS
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:IRENE
Authorized Official - Last Name:DIDOMENICO
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:973-634-5171
Mailing Address - Street 1:160 SAND SHORE RD
Mailing Address - Street 2:
Mailing Address - City:BUDD LAKE
Mailing Address - State:NJ
Mailing Address - Zip Code:07828-1511
Mailing Address - Country:US
Mailing Address - Phone:973-634-5171
Mailing Address - Fax:
Practice Address - Street 1:364 MAIN ST STE 1
Practice Address - Street 2:
Practice Address - City:BEDMINSTER
Practice Address - State:NJ
Practice Address - Zip Code:07921-2592
Practice Address - Country:US
Practice Address - Phone:973-634-5171
Practice Address - Fax:862-205-6072
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BRIDGES COUNSELING
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-04-15
Last Update Date:2020-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
No251S00000XAgenciesCommunity/Behavioral Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ37PC001317200OtherNJ DIVISION OF CONSUMER AFFAIRS