Provider Demographics
NPI:1952484016
Name:BRIDGES, DELESTER MAE (MFT MARRIAGE FAMILY)
Entity Type:Individual
Prefix:MRS
First Name:DELESTER
Middle Name:MAE
Last Name:BRIDGES
Suffix:
Gender:F
Credentials:MFT MARRIAGE FAMILY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3807 PASADENA AVE STE 115
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95821-2880
Mailing Address - Country:US
Mailing Address - Phone:916-484-7522
Mailing Address - Fax:916-484-7522
Practice Address - Street 1:3807 PASADENA AVE STE 115
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95821
Practice Address - Country:US
Practice Address - Phone:916-484-7522
Practice Address - Fax:916-484-7522
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2018-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC26006106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist