Provider Demographics
NPI:1255642385
Name:DWYER, BRIDGET M (MSCCC-SLP)
Entity type:Individual
Prefix:MS
First Name:BRIDGET
Middle Name:M
Last Name:DWYER
Suffix:
Gender:F
Credentials:MSCCC-SLP
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Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1 UNIVERSITY PLZ
Mailing Address - Street 2:LIU-BROOKLYN, METCALFE BLDG 257
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-5301
Mailing Address - Country:US
Mailing Address - Phone:718-488-3481
Mailing Address - Fax:718-488-3483
Practice Address - Street 1:1 UNIVERSITY PLZ
Practice Address - Street 2:LIU-BROOKLYN, METCALFE BLDG 257
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-5301
Practice Address - Country:US
Practice Address - Phone:718-488-3481
Practice Address - Fax:718-488-3483
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-23
Last Update Date:2010-06-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY004541-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist