Provider Demographics
NPI:1831462027
Name:BRIDGEMAN, JUDITH ANNE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:JUDITH
Middle Name:ANNE
Last Name:BRIDGEMAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:741 W TYROLEAN CT
Mailing Address - Street 2:
Mailing Address - City:CANON CITY
Mailing Address - State:CO
Mailing Address - Zip Code:81212-4393
Mailing Address - Country:US
Mailing Address - Phone:719-275-7916
Mailing Address - Fax:719-275-4209
Practice Address - Street 1:741 W TYROLEAN CT
Practice Address - Street 2:
Practice Address - City:CANON CITY
Practice Address - State:CO
Practice Address - Zip Code:81212-4393
Practice Address - Country:US
Practice Address - Phone:719-275-7916
Practice Address - Fax:719-275-4209
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-17
Last Update Date:2012-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9912661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical