| Bridge Counseling Center Inc | |
|
269 E Main St Suite F2 Smithtown NY 11787-2832 | |
| (631) 360-6695 | |
| Not Available |
| Full Name | Bridge Counseling Center Inc |
|---|---|
| Speciality | Social Worker |
| Location | 269 E Main St, Smithtown, New York |
| Authorized Official Name and Position | Lisa F Raia (PRESIDENT , DIRECTOR) |
| Authorized Official Contact | 6313606695 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Bridge Counseling Center Inc Po Box 286 Smithtown NY 11787-0286 Ph: (631) 360-6695 | Bridge Counseling Center Inc 269 E Main St Suite F2 Smithtown NY 11787-2832 Ph: (631) 360-6695 |
| NPI Number | 1609812130 |
|---|---|
| Provider Enumeration Date | 06/22/2006 |
| Last Update Date | 07/20/2021 |
| Certification Date | 07/20/2021 |
| Medicare PECOS PAC ID | 0446250427 |
|---|---|
| Medicare Enrollment ID | O20061226000152 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1609812130 | NPI | - | NPPES |
| 6020754230 | Medicaid | NY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | 075024-1 (New York) | Primary |
| Provider Name | Lisa F Raia |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1285708321 PECOS PAC ID: 1759342884 Enrollment ID: I20041022000175 |
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