Provider Demographics
NPI:1780499269
Name:AGUILAR-DISHMAN, BRIDGETTE PAIGE
Entity type:Individual
Prefix:
First Name:BRIDGETTE
Middle Name:PAIGE
Last Name:AGUILAR-DISHMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1110 FIDLER LN APT 506
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-3448
Mailing Address - Country:US
Mailing Address - Phone:240-355-0071
Mailing Address - Fax:
Practice Address - Street 1:6861 ELM ST STE 3A
Practice Address - Street 2:
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22101-6036
Practice Address - Country:US
Practice Address - Phone:571-200-5518
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-11
Last Update Date:2025-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0704017394101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional