Bridge Back To Life Center, INC.
Social Worker, Clinical in Brooklyn, NY. Organization (NPI-2).
NPI number1184041998
StatusActive
Last updated in NPPESNov 7, 2018
Details
- NPI
- 1184041998
- Entity type
- Organization (NPI-2)
- Legal business name
- Bridge Back To Life Center, INC.
- Organization subpart
- No
- Enumeration date
- Mar 19, 2014
- Last updated
- Nov 7, 2018
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1041C0700X | Social Worker, Clinical | 141111254 | NY | Yes |
| 163WA0400X | Registered Nurse, Addiction (Substance Use Disorder) | 141111254 | NY |
Practice location
3044 Coney Island Ave3rd Floor
Brooklyn, NY 11235-5660
Phone 718-265-4200 · Fax 718-265-8536
Mailing address
4271 Hempstead TpkeBethpage, NY 11714-5708
Phone 516-520-6600 · Fax 516-520-6750
Authorized official
Gary Butchen
President
5165206600
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