Provider Demographics
NPI:1780012138
Name:THREAT, BRIDGETTE LORI (LCSW-C)
Entity Type:Individual
Prefix:MRS
First Name:BRIDGETTE
Middle Name:LORI
Last Name:THREAT
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 MINK HOLLOW CT
Mailing Address - Street 2:
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-4868
Mailing Address - Country:US
Mailing Address - Phone:443-621-8886
Mailing Address - Fax:
Practice Address - Street 1:5 MINK HOLLOW CT
Practice Address - Street 2:
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117-4868
Practice Address - Country:US
Practice Address - Phone:443-621-8886
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-23
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD17801104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker