Provider Demographics
NPI:1881844066
Name:BRIDGE OVER TROUBLED WATERS
Entity Type:Organization
Organization Name:BRIDGE OVER TROUBLED WATERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INTERIM EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:COLLIGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-423-9575
Mailing Address - Street 1:47 WEST ST
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02111-1219
Mailing Address - Country:US
Mailing Address - Phone:617-423-9575
Mailing Address - Fax:857-277-6465
Practice Address - Street 1:47 WEST ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02111-1219
Practice Address - Country:US
Practice Address - Phone:617-423-9575
Practice Address - Fax:857-277-6465
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-24
Last Update Date:2008-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA0567251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health