Provider Demographics
NPI:1780854984
Name:BRIDGEFORTH, ARCHER E (LCSW)
Entity type:Individual
Prefix:MR
First Name:ARCHER
Middle Name:E
Last Name:BRIDGEFORTH
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:69 TIMBER TRL
Mailing Address - Street 2:
Mailing Address - City:WETHERSFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06109-1454
Mailing Address - Country:US
Mailing Address - Phone:860-257-3722
Mailing Address - Fax:
Practice Address - Street 1:85 LEXINGTON ST
Practice Address - Street 2:
Practice Address - City:NEW BRITAIN
Practice Address - State:CT
Practice Address - Zip Code:06052-1416
Practice Address - Country:US
Practice Address - Phone:860-223-1111
Practice Address - Fax:860-224-7200
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-04
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0066461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical