Provider Demographics
NPI:1336215995
Name:HANNAHAN, BRIDGET O (PHD)
Entity Type:Individual
Prefix:
First Name:BRIDGET
Middle Name:O
Last Name:HANNAHAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1768
Mailing Address - Street 2:
Mailing Address - City:POINT CLEAR
Mailing Address - State:AL
Mailing Address - Zip Code:36564-1768
Mailing Address - Country:US
Mailing Address - Phone:251-421-4313
Mailing Address - Fax:
Practice Address - Street 1:3168 MIDTOWN PARK S STE E
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36606-4123
Practice Address - Country:US
Practice Address - Phone:251-421-4313
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2021-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103TB0200X
AL774103TC2200X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09070760Medicaid
AL51539165OtherBLUE CROSS BLUE SHIELD
AL890019220Medicaid
AL051558630Medicare PIN