Provider Demographics
NPI:1255712394
Name:BRIDGES TO SUCCESS LLC
Entity type:Organization
Organization Name:BRIDGES TO SUCCESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JUNE
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:LPC LADC SAP
Authorized Official - Phone:203-296-0690
Mailing Address - Street 1:1674 ELLA T GRASSO BLVD
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-2802
Mailing Address - Country:US
Mailing Address - Phone:203-296-0690
Mailing Address - Fax:203-900-0690
Practice Address - Street 1:30 HAZEL TER
Practice Address - Street 2:SUITE C
Practice Address - City:WOODBRIDGE
Practice Address - State:CT
Practice Address - Zip Code:06525-2240
Practice Address - Country:US
Practice Address - Phone:203-296-0690
Practice Address - Fax:203-900-0690
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-15
Last Update Date:2015-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000272251S00000X
CT002456251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001451205Medicaid