| Bridge Vision Licensed Clinical Social Worker | |
|
357 W 2nd St Ste 3 San Bernardino CA 92401-1803 | |
| (909) 936-3888 | |
| (909) 635-6173 |
| Full Name | Bridge Vision Licensed Clinical Social Worker |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 357 W 2nd St Ste 3, San Bernardino, California |
| Authorized Official Name and Position | Colleen Nomsa Chali (CLINICAL DIRECTOR) |
| Authorized Official Contact | 9099363888 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Bridge Vision Licensed Clinical Social Worker 255 N D St Suite 401h San Bernardino CA 92401 Ph: (909) 936-3888 | Bridge Vision Licensed Clinical Social Worker 357 W 2nd St Ste 3 San Bernardino CA 92401-1803 Ph: (909) 936-3888 |
| NPI Number | 1083069850 |
|---|---|
| Provider Enumeration Date | 04/29/2016 |
| Last Update Date | 10/18/2019 |
| Medicare PECOS PAC ID | 1759718620 |
|---|---|
| Medicare Enrollment ID | O20200305002340 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1083069850 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | LCSW29187 (California) | Primary |
| Provider Name | Courtney Roushion |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1568939924 PECOS PAC ID: 9830527894 Enrollment ID: I20200325002076 |
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