Provider Demographics
NPI:1134541931
Name:BRIGHTENING HORIZONS
Entity type:Organization
Organization Name:BRIGHTENING HORIZONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SHELDON
Authorized Official - Middle Name:
Authorized Official - Last Name:WAGNER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:508-990-1620
Mailing Address - Street 1:427 COUNTY ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:NEW BEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02740-5001
Mailing Address - Country:US
Mailing Address - Phone:508-990-1620
Mailing Address - Fax:508-990-8118
Practice Address - Street 1:427 COUNTY ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:NEW BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02740-5001
Practice Address - Country:US
Practice Address - Phone:508-990-1620
Practice Address - Fax:508-990-8118
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-13
Last Update Date:2014-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1-12-10449103K00000X
MA4917103T00000X
MA1-04-2018103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty