Provider Demographics
NPI:1255151817
Name:BRIDGEWAY BEHAVIORAL HEALTH SERVICES
Entity type:Organization
Organization Name:BRIDGEWAY BEHAVIORAL HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT OUTPATIENT
Authorized Official - Prefix:MS
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:R
Authorized Official - Last Name:SIMON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:908-403-6516
Mailing Address - Street 1:373 CLERMONT TER
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083-8073
Mailing Address - Country:US
Mailing Address - Phone:908-355-7886
Mailing Address - Fax:
Practice Address - Street 1:506 3RD ST FL 1
Practice Address - Street 2:
Practice Address - City:HOBOKEN
Practice Address - State:NJ
Practice Address - Zip Code:07030-1970
Practice Address - Country:US
Practice Address - Phone:201-885-2539
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-16
Last Update Date:2024-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health