Provider Demographics
NPI:1780042374
Name:RIVERA, BRIDGETT (LPCC-S, LICDC)
Entity Type:Individual
Prefix:
First Name:BRIDGETT
Middle Name:
Last Name:RIVERA
Suffix:
Gender:F
Credentials:LPCC-S, LICDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 362
Mailing Address - Street 2:
Mailing Address - City:SYCAMORE
Mailing Address - State:OH
Mailing Address - Zip Code:44882-0362
Mailing Address - Country:US
Mailing Address - Phone:419-721-1810
Mailing Address - Fax:
Practice Address - Street 1:202 EAST SAFFLE AVENUE
Practice Address - Street 2:
Practice Address - City:SYCAMORE
Practice Address - State:OH
Practice Address - Zip Code:44882-0362
Practice Address - Country:US
Practice Address - Phone:419-934-2214
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-10
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC1400098101Y00000X
OH111130101YA0400X
OHE.2001602-SUPV101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)