Provider Demographics
NPI:1780764621
Name:BRIDGEWATER, HAROLD (CASAC)
Entity type:Individual
Prefix:
First Name:HAROLD
Middle Name:
Last Name:BRIDGEWATER
Suffix:
Gender:M
Credentials:CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 REMSEN ST
Mailing Address - Street 2:10TH FLOOR
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-4300
Mailing Address - Country:US
Mailing Address - Phone:718-852-5552
Mailing Address - Fax:718-852-5666
Practice Address - Street 1:175 REMSEN ST
Practice Address - Street 2:10TH FLOOR
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-4300
Practice Address - Country:US
Practice Address - Phone:718-852-5552
Practice Address - Fax:718-852-5666
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY8660101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)