Provider Demographics
NPI:1922872886
Name:THERAPEUTIC BRIDGES, LLC
Entity Type:Organization
Organization Name:THERAPEUTIC BRIDGES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO AND OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:MENKE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-C, LICSW, MSW
Authorized Official - Phone:443-515-7067
Mailing Address - Street 1:445 E FORT AVE APT B
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21230-4655
Mailing Address - Country:US
Mailing Address - Phone:443-515-7067
Mailing Address - Fax:
Practice Address - Street 1:445 E FORT AVE APT B
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21230-4655
Practice Address - Country:US
Practice Address - Phone:443-515-7067
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-10
Last Update Date:2023-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty