Provider Demographics
NPI:1922266329
Name:MICKERE, BRIDGET BROWNING (MA)
Entity Type:Individual
Prefix:MRS
First Name:BRIDGET
Middle Name:BROWNING
Last Name:MICKERE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1141 CLAY AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:DUNMORE
Mailing Address - State:PA
Mailing Address - Zip Code:18510-1191
Mailing Address - Country:US
Mailing Address - Phone:570-963-2079
Mailing Address - Fax:570-963-1953
Practice Address - Street 1:1141 CLAY AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:DUNMORE
Practice Address - State:PA
Practice Address - Zip Code:18510-1191
Practice Address - Country:US
Practice Address - Phone:570-963-2079
Practice Address - Fax:570-963-1953
Is Sole Proprietor?:No
Enumeration Date:2008-06-02
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS007429L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist