Provider Demographics
NPI:1992839633
Name:AUSTIN, BRIDGET (CAS)
Entity Type:Individual
Prefix:
First Name:BRIDGET
Middle Name:
Last Name:AUSTIN
Suffix:
Gender:F
Credentials:CAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 WEST MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:SAN JACINTO
Mailing Address - State:CA
Mailing Address - Zip Code:92583-2722
Mailing Address - Country:US
Mailing Address - Phone:951-327-5104
Mailing Address - Fax:951-929-6469
Practice Address - Street 1:102 W MAIN ST
Practice Address - Street 2:
Practice Address - City:SAN JACINTO
Practice Address - State:CA
Practice Address - Zip Code:92583-4121
Practice Address - Country:US
Practice Address - Phone:951-327-5104
Practice Address - Fax:951-929-6469
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2008-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health